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Central venous catheterisation
Central venous catheterisation
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Vascular access

  1. 1. Vascular Access<br />Mary Corcoran RN, BSN, MICN<br />
  2. 2. Peripheral Access<br />
  3. 3. Tips and Tricks<br /><ul><li>Peripheral Access is obtained using Aseptic technique
  4. 4. Initial insertion attempts should begin distally and progress up the extremity
  5. 5. If the situation and pt vasculature allow
  6. 6. During resuscitation peripheral access is preferred to eliminate interruption in chest compression for central line insertion
  7. 7. Proximal veins may be used when giving medication with extremely short half life, or for rapid fluid or CT contrast infusion
  8. 8. Adenosine
  9. 9. Scalp Veins have no valves and are easily visible on infants- allowing infusion in both directions</li></li></ul><li>Infiltration of fluid or medication (can cause necrosis with certain meds)<br />Phlebitis<br />Embolism<br />Of blood, air, or catheter fragments<br />Infection<br />Cellulitis<br />Needle stick and blood exposure for RN<br />Potential Complications<br />
  10. 10. In ER- anywhere you can find a vein<br />Arms, legs, Neck, Abdomen, Hands, Feet, Breasts etc…<br />Most Common are<br />Hands, A/C (antecubital), Forearms, and EJ’s (external Jugular)<br />Just make sure to always point toward the heart <br />**note: check with your facility for specific locations and protocols<br />Location<br />
  11. 11. Size and Type of cath are determined by urgency of need, patient size and vasculature<br />Larger Diameter (12,14,16,18g)- used for rapid fluid, drug, or blood infusion<br />Smaller Catheter (20,22,24g)- are used for routine vascular access, and patients with smaller veins<br />Catheter Selection <br />
  12. 12. IV Insertion<br />
  13. 13. Central Venus Access <br />
  14. 14. Subclavian Vein- under the clavicle<br />Internal Jugular- also under the clavicle <br />Femoral Vein- In the groin<br />Where are they placed?<br />
  15. 15. Why do we place them?<br />Short Term<br />When all other peripheral access is unavailable<br />When condition is unstable and requires hemodynamic monitoring (eg CVP)<br />Prolonged IV Therapy<br />TPN, extended Abx therapy, or caustic medication administration <br />Vancomycin<br />Debilitating diseases <br />AIDS, Cancer<br />Long Term<br />
  16. 16. Central Line Insertion<br />
  17. 17. Venus Access Devices<br />
  18. 18. Intraosseous Infusion<br />
  19. 19. Inserted in to the bone marrow, blood can be drawn from the marrow, and fluids, medication, and blood infused through the marrow<br />Used on adults and pediatric patients<br />When all else fails…<br />
  20. 20. Anterior Tibia, Medial Malleolus, Sternum, Distal Femur, Humerus, or Iliac Crest<br />Where do we place them?<br />
  21. 21. You Tube Video for Humeral IO, staring someone familiar…..<br />
  22. 22. Sternal IO insertion- only done in military currently<br />
  23. 23. Fluid and Blood Replacement<br />
  24. 24. Maintenance IV Fluid<br />
  25. 25. Whole Blood<br />Unfiltered and carries significant risks of infection and transmission, is expensive, and not readily available<br />PRBC’s (Packed Red Blood Cells)<br />Are used most often for blood replacement<br />FFP (Fresh Frozen Plasma)<br />Contains Clotting Factors<br />Albumin (5% isoonocoit, 25% isotonic “salt poor”)<br />Used as volume expander when risk of interstitial edema is great (pulmonary/cardiac disease)<br />Blood Administration <br />
  26. 26. Blood Compatibility <br />
  27. 27. Transfusion Reactions <br />Hemolytic<br />Cause- Blood Incompatibility<br />Prevention- Type and Crossmatch, infuse first 50cc slowly<br />Assessment- Fever, Chills, Dyspnea, Tachypnea, fever, olguria, hematuria, chest tightness<br />Collect blood and urine<br />Intervention- Discontinue Immediately FATALITY may occur after 100cc, start NS or LR, consider diuretics, and monitor BUN, Creatinine<br />
  28. 28. Transfusion Reaction<br />Allergic <br />Cause- Antibody Reaction to allergens<br />Prevention- Screen donors for allergy; administer antihistamines (Benadryl) prior to transfusion<br />Assessment- Chills, hives, wheezing, vertigo, Anaphlaxis, dyspnea, bronchospasm and generlized edema<br />Intervention- Stop Infusion, give antihistamines, epi, NS or LR<br />
  29. 29. Transfusion Reactions<br />Circulatory overload<br />Cause-infusion of large amounts of blood, especially to elderly, or cardiac hx<br />Prevention- Infuse Slowly; check drip rate and frequency<br />Assessment- Pulmonary Crackles, Cough, dyspnea, pulmonary edema, increased CVP<br />Intervention- Stop infusion, treat pulmonary edema<br />
  30. 30. Transfusion Reaction<br />Hypocalcaemia<br />Cause-Precipitate from acid citrate dextrose calcium dilution with massive transfusions<br />Prevention- use blood immediately<br />Assess- Numbness, and tingling to extremities<br />Intervention- Stop infusion, give Calcium <br />Hyperkalemia<br />Cause- Hemolysis of red blood cells Release Potassium<br />Prevention- Use blood immediately<br />Assess- Nausea, Vomiting, Muscle weakness, bradycardia<br />Intervention- stop Infusion<br />