S4C33 - Venous and IO Access in Adults

Question 1

Femoral Vein

Answer 1

-medial to femoral artery

Question 2

What not to administer via peripheral IV

Answer 2

• sclerosing agents
• concentrated electrolytes or glucose solutions
• cytotoxic chemo agents

Question 3

IJ - internal jugular

Answer 3

• lies lateral to the carotid artery
• the IJ joins the subclavian vein to form the brachocephalic vein
• complications: infxn, bleeding, pneumo, may injure the carotid artery and disturb a plaque leading to a stroke, airway compromise from a hematoma
• right better than left b/c straighter course and less injury to thoracic duct
• central approach: triangle created by clavicle and the two heads of the SCM, insert needle in triangle at 30-45deg angle 1cm below apex of triangle parallel to the carotid artery located medially directed towards the ipsilateral nipple, should get venous blood w/in 1-3cm of needle advancement
• posterior approach: lateral aspect of clavicular portion of SCM, 1/3 distance from the clavicle to the mastoid process with needle directed towards sternal notch, venous return should occur w/in 3-5cm of needle advancement
• anterior approach - identify pulse of carotid artery , hold it with fingers in L hand, enter at a 30-45deg angle to the midpoint of the medial aspect of the sternal portion of the SCM muscle, aim toward the ipsilateral nipple, venous return should occur w/in 3-5c of advancement

Question 4

Subclavian Vein

Answer 4

• crosses under the clavicle at the medial to proximal third of the clavicle
• the subclavian artery lies posterior and superior to the brachiocephalic vein
• infraclavicular approach: trendelemburg, head neutral, enter at jxn of middle and medial thirds of clavicle with bevel held inferomedially to direct guidwire to brachiocephalic trunk rather than the IJ, direct needle towards suprasternal notchat 10deg angle parallel to the surface of chest, walk the needle down the clavicle until needle is posterior to it, should have venous return by 3-5cm of depth
• supraclavicular approach: enter 1cm lateral to the clavicular head of the SCM and 1cm posterior to the clavicle at angle of 10deg above horizontal, orient bevel medially insert towards contralateral nipple, venous return usually in 2-3cm

Question 5

Femoral Vein Central Line

Answer 5

• position - reverse trendelenburg with hip slightly abducted and leg slightly externally rotated, femoral veing is medial to artery and 1-2cm below the inguinal ligament
• if pt arrested, place your thumb on pubic tubercle and index finger on ASIS, femoral vein will be located at the interdigital space (the ‘V’ of the finger and thumb) just inferior to the inguinal ligament
• **alway insert needle below inguinal ligament otherwise may cause sever retroperitoneal hemorrhage

Question 6

ETT meds

Answer 6

LEAN

• lidocaine
• epinephrine 1:1000 with 1mg/ml — dose is 2mg ETT
• atropine
• naloxone

-in general double or triple the IV dose strength and dilute in 3-5cc of normal saline