vasc access & feeding tubes (Lanaux) Flashcards
1
Q
Meds with > 600 mOsm
A
- should only be admined through central line
- total parenteral nutrition
- CRI dextrose > 5%
*meds < 600 mOsm can give in peripheral vein
2
Q
Poiseuille’s law
A
- radius4 big variable in determing flow of something
3
Q
Which will cause greatest decrease in flow through a catheter?
TQ
a. doubling diameter of catheter
b. halving diameter of the catheter
c. doubling the length of the catheter
d. halving the length of the cath
A
b. halving diameter of catheter
4
Q
Sites of access
A
- cephalic vein
- lateral and medial saphenous veins
- jugular vein
- auricular veins (Dog)
5
Q
central line placement
sites of access
A
- Jugular vein
- Medial and lateral saphenous veins
*PIC lines
6
Q
Types of catheters
A
- Winged or Butterfly needle
- SQ fluids
- short term admin
- blood draws
- Over-the-needle
- normal ones
- Through-the-needle
- push pops
- single or multilumen
- long terms
7
Q
Complications catheterization
A
- Phlebitis
- inflammation of vessel wall
- from endothelial lining damage
- CS
- swelling
- tenderness
- erythema over vessel
- mech damage
- admin of hyperosmotic fluids
- infection
- Thrombosis
- Catheter embolism
- Fragment of cath breaks off and enters circulation
- SQ fluid infiltration into tissue
- backed out
- upstream venous thrombosis
- Infection
- local cellulitis/phlebitis
- systemic
- Hemorrhage
8
Q
Placement of peripheral catheters
A
- shave, aseptic scrub
- occlude vein upstream
- insert bevel up 15 deg angle
- after flash advance 1-4 mm more
- advance cath off needle
- cap, flush
- secure
9
Q
Facilitative incision/relief hole
A
- small incision through tough skin
- # 11 scalpel blade
- cutting edge of 20 guage needle
- prevents flaring of cath tip
10
Q
Venous cut down
A
- aseptic prep, local anesthetic
- NOT IV
- 1-2 cm skin incision parallel to vein
- Dissect out vein and isolate w/ hemostats/suture
- place cath directly through superficial vessel wall
11
Q
Central venous cath
A
- Terminate in cranial/caudal vena cava
- Uses
- hemodynamic monitoring (CVP)
- admin meds and fluids
- seriel blood sampling
- allows longer term venous access
- Maintenance
- inc severity of complications
- aseptic technique
- foreign material
- infectious agents
- Open air ports => air embolism
- one-way locking valves to cap ports
- Inadvertent disconnections => hemorrhage
12
Q
Seldinger technique
A
- Use smaller introducing cath/trochar and guidwire
- Can be used to replace existing cath in same location
- Technique
- Clip and aseptic prep
- drape using sterile technique
- surgeon/assistants wear sterile gloves, gown, cap, mask
- relief incision with scalpel
- cath wtih short over needle cath
- guidewire threaded through over needle cath
- J-tip protects against puncture
- always hold guidwire
- remover over needle cath, stabilize guidewire
- vessel dilate used over guidewire
- large bore cath threaded onto guidewire, advance into dilated vessel
- guidewire removed, aspirate larger cath to remove air, flush and secure (suture)
13
Q
IO catheterization
A
- access to capillaries in bone marrow
- useful in neonates, or vasc collapse
- Can cause discomfort
14
Q
Mean IO flow rates crystalloid solns delivered under pressure (300 mmHg) limited to approx ?????? in puppies?
A
29 mL/min
15
Q
IO contraindications
A
- Don’t do in recently fractured bones
- Don’t do in pneumatic bones of birds
- will drown them
- Inc risk extravasation if in same bone as failed earlier attempt where cortex has been penetrated
