Advanced skills Flashcards
where are the main sites for iv access
ACF ( antecubital fossa)
hand
forearm
where are other sites to consider for iv access
foot
jugular
what are the techniques to encourage vasodilation
tourniquet gravity bp cuff fist clenching vein tapping- no slapping warmth multiple tourniquets
what is the process of cannulation
1. Introductions, explain procedure, gain consent 2. Site considerations 3. Optimal conditions for cannulation 4. IPC/PPE 5. Arrange and check equipment 6. Apply tourniquet 7. Identify vein 8. Disinfect 9. Choose cannula (can remove end cap and place on insertion cap) 10. Apply traction and anchor vein 11. Insert cannula at 10-30o – See primary flashback 12. Lower angle, advance a small amount, partially withdraw needle (keep cannula insitu) – see secondary flashback 13. Fully advance cannula 14. Hold cannula and remove tourniquet 15. Apply pressure to distal end of cannula, withdraw needle entirely 16. Replace end cap on cannula 17. Cover with dressing 18. Flush cannula with saline 19. Label and document cannul
what are the complication of iv access
- On-scene times
- Infection
- Failure
- Sharp injuries
- Accidental removal
- Haematoma
- Cannula occlusion
what are the indications for io access
When IV access is extremely difficult or impossible for: • Drug Therapy • Fluid Therapy Any time the patient is time-critical you should consider IO if IV is impossible: • Trauma • Cardiac Arrest • Respiratory emergencies • Systemic emergencies
what are the contraindications of io access
Contraindications: • Prosthetics • Significant trauma to bone (or suspected) • IO or attempted IO within 48 hours • Infection • Excessive tissue (Severe obesity) • Unable to identify landmarks
what is the equipment needed for io access
- EZ-IO device
- EZ-IO needle
- Swab
- Sharps bin
- Clinical waste bag
- 10ml syringe/flush
- Three-way tap
- Luer-lock attachment
- IO Dressing
- PPE
what are the sites of io access
proximal humours
distal femur
proximal tibia
distal tibia
what is the process for io access
. Identifies indication
2. Introductions, explain procedure, gain consent
3. Site considerations
4. Optimal conditions for attempt
5. IPC/PPE
6. Arrange and check equipment – prime luer-lock and
three-way tap
7. Identify site
8. Disinfect
9. Choose needle size and attach to driver
10. Insert needle at 90 degrees until bone is met - ensure
5mm mark is visible
11. Engage driver using slight pressure until a loss of
resistance is felt
12. Unscrew and remove stylet and dispose of sharps
13. Aspirate slightly – should see blood
14. Flush with saline rapidly. Use 10ml+
15. Attach primed luer-lock and three-way tap
16. Cover with dressing
17. Label and document
what is circulatory shock
“acute circulatory failure with inadequate or
inappropriately distributed tissue perfusion resulting in
generalised cellular hypoxia”
what are the requirements of cells
Cells need two things; oxygen and
glucose.
• Cells carry oxygen through blood to
tissue
what happens in shock to the cells
issue in shock is perfusion – there is not enough oxygen in the blood for the oxygenation of the tissue so energy cannot be created to sustain life.
what are the types of shock
- Hypovolaemia
- Obstructive
- Distributive
- Cardiogenic
- Dissociative
what is hypovolaemic shock
Low blood volume due to a loss in cumulative volume.
