Lecture Notes

Question 1

What you need to know before you stick

Answer 1

• What is the planned surgery?
• What side?
• Planned positioning?
• Major blood loss possible?
• Labs needed?

Question 2

Where to stick it

Answer 2

”- Avoid upper extremity side that drains to a lymph node dissection site

• Make sure you can access during surgery
• Start distal”

Question 3

What size IV?

Answer 3

”- Large bore (16G-18G) when pt is asleep

- Small bore (20G-22G) to induce”

Question 4

Antecubital Vein: Pro

Answer 4

”- Easy/less painful

- Large”

Question 5

Antecubital Vein: Con

Answer 5

”- Not useable during prone spine surgery

• Uncomfortable for pt
• Difficult to detect if infiltrated “

Question 6

Catheter size for normovolemic pt

Answer 6

• 22G

Question 7

Catheter size for slightly hypovolemic pt

Answer 7

• 20G

Question 8

Catheter size for elective blood transfusion

Answer 8

• 20G

Question 9

Catheter size for moderately likely moderate bleeding

Answer 9

• 18G

Question 10

Catheter size if massive transfusion/fluid replacement is likely

Answer 10

• 2 X 16G

Question 11

What happens if you miss your best option for an IV?

Answer 11

• Central line

Question 12

Complications associated w/ Central Lines

Answer 12

”- Infection

• Arterial puncture, hematoma, stroke
• Pneumothorax
• Hemothorax, chylothorax
• Air embolism
• Cardiac trauma
• Dysrhythmia”

Question 13

Where does the tourniquet go?

Answer 13

”- Close to the puncture site

- Proximal is okay as longs as the vein stands up”

Question 14

What defines a good stick?

Answer 14

”- Being able to advance the catheter to the hub

• Good backbleed
• No infiltration
• Ability to push a large bolus rapidly”