complications key points Flashcards
issues leading to complications
reliance on flumazenil bolus sedation still used untrained sedationists incorrect doses - labels, incorrect conc
complications of IV cannulation
extravascular injection venospasm intraarterial injection haematoma fainting
venospasm
disappearing vein syndrome - vein disappears as you put cannula in
veins collapse at attempted venepuncture
may be accompanied by burning
associated with poorly visible veins
management of venospasm
time dilating vein - torniquet, tap vein - worse with repeated attempts efficient technique - slow skin puncture makes worse warm water/gloves in winter - dilates vessels
extravascular injection
active drug placed into interstitial space (cannula not in)
diagnosis of extravascular injection
pain
swelling
extravascular injection potential problems
delayed absorption (will get absorbed at some time - oversedation?)
preventing extravascular injection
good cannulation
test dose of saline - flush cannula
tx of extravascular injection
remove cannula
apply pressure
reassure
intra-arterial injection - where is it most likely?
rare antecubital fossa (brachial artery)
diagnosis of intra-arterial injection
pain on venepuncture (wall thicker)
red blood in cannula, bubbles
difficult to prevent leaks
pain radiating distally from cannulation site
loss of colour/warmth to limb/weakening pulse
prevention of intra-arterial injection
avoid anatomically prone sites - ACF medial to biceps tendon
palpate before attack (if pulse not vein)
if have cannulated an artery - take out and apply pressure DON’T inject drug
management of intra-arterial injection
monitor for loss of pulse (if artery irritated may constrict) - cold/discolouration
leave cannula in situ for 5mins post-drug
- no problems then remove
- symptomatic - leave and refer to hospital
haematoma
bruise
extravasation of blood into STs
- due to damage to vein walls
when can haematoma occur?
at venepuncture - poor technique
removal of cannula - failure to apply pressure
care w elderly