peripheral vascular Flashcards
brachial artery use
stanard blood pressure cuff
radial artery
pulse with this
ulnar artery
arterial line
invasive blood pressure line
allens test positive?
means patient does NOT have an adequate dual blood supply to the hand
allens test
arteries of the upper extremity
make a fist then occlude
- ulnar and radial artery
- if pinks up – know have the flow
if let go of artery and does not pink up – not putting line here because if do - loss of blood supply to the area
fist - then open up hand
arteries of the lower extremity
femoral artery
popliteal artery - hard to palpate
dorsalis pedis artery
posterior tibial artery
veins - very baic
superficial and deep veins
have vlaves – if get back flow can go into superficial areas and get varicosities
athrosclerosis (arteriosclerosis obliterans)
intermittent claudication
symptom of pain or cramping in legs during exercise that is relieved by rest within 10 minutes
usually in calf muscles
not total occlusion but some
acute arterial occlusion?
implication
usually superimposed on the artersclerosis obliterans
- such as a embolism and thrombosis
weakness to area
absent or weak distal pulses
raynaud’s disease
episodes of sharpley demarcated pallor of fingers aggrevated by exposure to cold
varicosities
enlarged / twisted veins at the skin surface
- occurs due to malfunctioning of valves
trendelenberg test – will see blood flow out
DVT
homan sign
lay flat on bed and thought had DVT
- take foot and elicit pain when flex it
venous insufficiency
engorgment of blood in the veins secondary to either valve incompetency or occlusion
characterized by chronic edema, pigmentation and possibly ulceration
edema types
pitting
chronic venous insufficiency
lymphoedema
pitting edema
soft with pitting
results from CHF, nephrotic syndrome or malnutrition
chronic venous insuffciency related to edema
soft with pitting
characterized by chronic edema, pigmentation and possibly ulceration
lymphoedema
becomes indurated
non-pitting – not getting the indentations after
FIRST SOFT THEN INDURATED HARD AND NON PITTING
if took IV or blood pressure on side that has previous excision or radiation to the nodes - could develop a lymphoedema
why laterally in the antecubetal fossa as opposed to medially?
concerned about anatomy
- more problomatic medial
locations to put an IV
start?
finish?
dorsum of hand ventral forearm lateral antecubital fossa dorsal wrist medial antecubital
dosrum of hand venipuncture site?irritation ?
no important anatomy - but the veins DO ROLL
can cause irritation adn burning
diazepam / valium can cause burning
ventral forearm venipuncture site?
no anatomy no rolling of veins
lateral anticubital fossa venipuncture site?
no anatomy no rolling of veins
*joint immobilization
metal needle only
dorsal wrist venipuncture site?
no anatomy
rolling of veins
*joint immobilization
metal needle only
medial antecubital fossa venipuncture site?
anatomy - yes worried about structures
no rolling of veins
*joint immobilization
metal needle only
no ___ in the IV lines
no air
supine position why
avoid going into syncopy
but up a little so breathing isnt compromised
angle to place IV in
30 degress
introducer does NOT move
catheter advances into vein
keep skin taught to help
IM injection technique
advantages
rapid onset of action (15 mins)
mac clinical effect - 30 mins
more reliable absorption than oral or rectal
patient coopreation not as essential
IM injection technique
disdvantages
inability to titrate
- 15 mins onset
inability to reverse drug action
prolonged duration of drug effect
injection needed
- possible injury from this
use intramuscular route when and why
older adults
- cant inhale or IV routes are unavailable
disruptive pediatric patient when other routes unaffective
disruptive child or adult with disabilities in other routes not effective
uses of the IM injection when indicated
premedication before IV sedation or general anesthesia in the precooperative pediatric patient or adult or peeds patient with disability
administration of antiemetics or anticholinergics
administratin of emergency drugs when IV administration is not available (like epi pen — lateral aspect of thigh)
give glucagno – in deltoid
seizure - IM versed
vastus lateralis
perfussion in adult?
hold how much?
where place epi pen on lateral aspect of the thigh
perfussion is 2 - can hold 8-15 ml
deltoid injection perfusion
adult
infant
1 perfussion
can hold 4 ml in adult
gluteal / ventrogluteal injection perfusion and adult amount hold
3 perfussion and hold 4-8 ml
