complications key points Flashcards

1
Q

issues leading to complications

A
reliance on flumazenil
bolus sedation still used
untrained sedationists
incorrect doses
 - labels, incorrect conc
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2
Q

complications of IV cannulation

A
extravascular injection
venospasm
intraarterial injection
haematoma
fainting
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3
Q

venospasm

A

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

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4
Q

management of venospasm

A
time dilating vein - torniquet, tap vein
 - worse with repeated attempts
efficient technique
 - slow skin puncture makes worse
warm water/gloves in winter - dilates vessels
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5
Q

extravascular injection

A

active drug placed into interstitial space (cannula not in)

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6
Q

diagnosis of extravascular injection

A

pain

swelling

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7
Q

extravascular injection potential problems

A

delayed absorption (will get absorbed at some time - oversedation?)

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8
Q

preventing extravascular injection

A

good cannulation

test dose of saline - flush cannula

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9
Q

tx of extravascular injection

A

remove cannula
apply pressure
reassure

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10
Q

intra-arterial injection - where is it most likely?

A
rare
antecubital fossa (brachial artery)
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11
Q

diagnosis of intra-arterial injection

A

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

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12
Q

prevention of intra-arterial injection

A

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

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13
Q

management of intra-arterial injection

A

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

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14
Q

haematoma

A

bruise
extravasation of blood into STs
- due to damage to vein walls

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15
Q

when can haematoma occur?

A

at venepuncture - poor technique
removal of cannula - failure to apply pressure
care w elderly

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16
Q

prevention of haematoma

A

good cannulation technique - avoid multiple holes in vein wall
pressure post-op by operator until stops bleeding, then apply pressure and get pt to put pressure

17
Q

haematoma tx

A

time, rest, reassurance
if severe initial ice pack, moist heat 20mins in hour after 24hrs
consider heparin containing gel

18
Q

fainting during venepuncture

A
quite common
anxiety related
worse if starved
prevention
 - don't starve pt
 - topical skin anaesthesia
 - RA first (IHS 1st - more O2)
 - position of pt - put them part-reclined
tx - raise legs
19
Q

complications of drug administration

A
parodoxical reactions
hyper-responders
hypo-responders
sexual fantasy
allergic reactions
oversedation
20
Q

hyper-responders

A
deep sedation with minimal dose (1-2mg)
care with titration
 - 1mg increments
 - slow in elderly (sensitivity to midazolam increases) and 
   U16s
 - max 3.5mg for >60yrs
21
Q

hypo-responders

A
little sedative effect with large doses
check cannula in vein (re-flush)
due to tolerance?
 - BZD induced
 - cross-tolerance e.g. cocaine
 - idiopathic
threshold to abandon? - not over 10mg, BNF max 7.5mg
22
Q

parodoxical reactions

A
don't sedate how you expect
appear to sedate normally
react extremely to all stimuli
relax when stimuli removed
check for failure of LA
don't continue adding sedative
find other management techniques
watch immature teenagers (U16s)
23
Q

allergic reactions

A

rare to sedatives
- do not use flumazenil (also a BZD)
latex and elastoplast
manage as if not sedated - advantage of IV access

24
Q

oversedation

A

loss of responsiveness
resp depression
- sometimes just need to give O2 and tell pt to take deep breaths
loss of ability to maintain airway - collapses
respiratory arrest

25
Q

complications of IHS

A

pt panics

oversedation

26
Q

cause of oversedation in IHS

A

initially - misjudge dose
later
- traumatic procedure over
- mouthbreathing ceases e.g. if hood doesn’t fit well then fixed later so getting higher conc

27
Q

IHS pt panics

A

enough sedation?
reassurance
if cannot cope abort

28
Q

S+S of oversedation

A
irrational and sluggish responses
pt discomfort
fails to respond to verbal cues/mild stimuli
incoherent speech
LOC
lack of cooperation
mouth closing repeatedly
eyes closed, unable to open
nausea and vomiting
spontaneous mouth breathing
pt no longer enjoying effects
drop in O2 sats
pulsing head/temples
uncontrolled laughter/tears
29
Q

what are 2 signs you should stop IHS?

A

ears ringing

sore head

30
Q

tx of IHS overdose

A

reduce N2O conc by 5-10%
reassure
don’t remove nosepiece - diffusion hypoxia
- 3-5mins
- diffusion gradient N2O rushes out, stops O2 in