Vascular Access and Monitoring Lecture Powerpoint Flashcards
What is intravenous access used for? (5)
- deliver fluid
- Deliver medication/IV contrast
- Give parental nutrition/electrolytes
- Deliver blood products/draw blood
- hemodialysis
Reasons for an arterial line (3)
- measure constant blood pressure
- drawing ABGs
- measure central venous pressure
Catheter sizing
Smaller the number gauge larger the bore of the needle
Goal catheter size gauge for adequate flow rate upon catheterization
20 gauge, ideally 18 (easier for IV contrast)
Peripheral IV access protocol (2)
- Can be done by many different healthcare providers
- should take 3 attempts, if cannot then second person tries, then if not IV team must be called
Advantages (3) and disadvantages (3) for peripheral IV access
\+ease of insertion \+ low cost \+minimal complications - short duration must be less than 3 days and cannot be used with certain medications -easily occluded -potential tissue injury
If labs are not drawn immediately upon a peripheral IV access being established, then…
….cannot draw blood labs later on as they are no longer accurate (need a different site)
Contraindications for peripheral IV establishment (7)
- If med can be given orally***
- cellulitis
- injury to extremity
- previous IV infiltration (IV not actually in vein)
- surgical procedures
- Burn
- AV fistula presence
Why might establishing a peripheral IV be difficult? (5)
- Dehydration
- shock
- IV substance abuse
- Obesity or being underweight
- Chemo
Typical placement areas of a peripheral IV (4)
- Dorsal hand
- forearm/wrist (cephalic or basilic vein)
- leg/ankle/dorsum of vein (greater saphenous vein)
- scalp in neonate
Gauge size needed in resuscitation to get large amounts of fluid/medications fast
16 gauge
Infiltration
Leakage of fluid or medications that can be given peripheral IV into surrounding tissue from being slightly pulled out causing swelling, discomfort, and burning
Extravasation
Accidental administration of toxic medications that should not be given IV into tissue around the infusion site that can cause tissue necrosis, disfigurement, or loss of function
Phlebitis
Blood clot in vein causing inflammation creating a red, warm, swollen, tender vein, common in superficial veins and don’t require concern but deep can increase risk for pulmonary embolism, indication to remove catheter
Examples of drugs that can cause extravasation if given peripheral IV (6)
- Chemotherapy
- K+
- vancomycin
- cefotaxime
- amiodarone
- calcium chloride
Indications for central venous catheter (6)
- Inadequate peripheral venous access
- administration of toxic medications (vasopressors, chemo, TPN)
- hemodynamic monitoring (measurement of CVP)
- extracorpeal (hemodialysis)
- rapid infusion of fluids/blood
- drawing frequent labs
Contraindications for a central venous catheter (4)
- all relative as these can be life saving
- anatomic distortion or trauma for specific sites
- hemodyalysis or pacemaker presence
- moderate to severe coagulopathy
PICC line
Central venous catheter inserted into cephalic, basilic, brachial vein into distal superior vena cava, less procedural risk than others as uses ultrasound guidance with an IV nurse with confirmation of placement via radiology, can be single or double lumen, used for temporary access infusion 15-30 days for things like IV antibiotics, chemo, or vasopressor medications, inserted in nondominant arm
Order of preference for PICC line vein choice
Basilic > brachial > cephalic > median cubital
Advantages (4) and disadvantages (2) of PICC line
\+ease of insertion \+relatively safe and inexpensive \+good for drawing several labs \+easy to remove -potential for occlusion -can take over 1 hour to place, not stat
PICC line complications (7)
- infection
- hemorrhage
- arterial puncture
- nerve injury
- pneumothorax
- thrombus
- phlebitis
Non tunnel (Quinton) central venous catheter
Percutaneously inserted into internal jugular, subclavian, or femoral vein with the catheter exiting the skin, can be up to quadruple lumen, short term use only for emergent situations and accounts for majority of central line associated blood stream infections
More lumens on a catheter increase higher rate of…
….venous thrombosis
Tunneled (hickman, groshong, broviac) central venous catheter
Implanted internal jugular, subclavian, or femoral vein useful for long term as has lower rate of infection, has a dacron cuff that inhibits migration of organisms into catheter after skin grows over, only lumen is exposed everything else is hidden
Central venous catheter advantages (4) and disadvantages (2)
\+long term access \+decreased infection rate in tunneled \+safe with most meds \+emergency access -requires surgical insertion often under sedation -increased cost
Implantable venous access port
Often used for same reasons as a tunneled central line, most often used for patient with chemotherapy, entirely under skin allowing for lowering risk of infection, can remain lifelong, much more cosmetic, medicines injected into skin thru catheter, after being filled reservoir slowly releases medicine into blood stream, except for flushing once a month no special care needed
Intraosseous access
Used in emergency situations, presence of vascular collapse (due to shock as blood shunts to core), in children/infants, or in trauma, bone marrow functions as a noncollapsible venous access allowing meds and fluids to enter central circulation in seconds, should only be done for an avg of 5.2 hours
Most common site of intraosseous access
Proximal tibia
Intraosseous access advantages (3) and disadvantages (2)
\+rapid and easy to insert \+low complication rate \+safe with resuscitation meds -short term only -potential for osteomyelitis or fracture
3 types of IV infusion pumps and complication (1)
- continuous infusion
- intermittent infusion (for like 3 antibiotic doses a day)
- patient controlled (PCA) (for narcotic pain control)
-still source of many injuries and some deaths secondary to infusion pump errors
