Vessel transillumination Flashcards
What is vessel transillumination used for?
Puncture for sampling and vessel cannulation
It helps locate the artery or vein.
What are the contraindications for vessel transillumination?
None
What precautions should be taken during vessel transillumination?
Cool light to prevent burns and maintain a sterile field
What are the complications associated with vessel transillumination?
Burns and cross-contamination
What are the indications for venipuncture?
- Blood sampling
- Blood culture
- Administration of medication
What are the contraindications for venipuncture?
- Presence of coagulation defect
- Local infection at puncture site
- Use of deep vein
- Femoral or internal jugular vein
- External jugular in certain conditions
What precautions should be taken during venipuncture?
- Universal precautions
- Neck veins as last resort
- Remove tourniquet before removing needle to minimize hematoma formation
What are the neonatal considerations for venipuncture?
- Preserve access by using distal sites first
- Use smallest gauge possible
- Pain control
What are the complications of venipuncture?
- Pain
- Hemorrhage
- Coagulation defect
- Puncture of deep vein
- Thrombosis or embolus
- Laceration of adjacent vessel
- Tourniquet damage
What are the indications for PIV placement?
- Fluid and/or nutritional requirements
- Administration of medications
- Vascular access
What precautions should be taken during PIV placement?
- Avoid areas adjacent to skin loss or local infection
- Avoid vessels across joints
- Differentiate veins from arteries
- Appropriate tourniquet use
- Avoid butterfly needles near flexion surface
- Preserve central access/distal sites first
What are the complications of PIV placement?
- Pain
- Hematoma
- Venospasm
- Phlebitis
- Infiltration of infusate
- Infection
- Embolization of clot
- Air embolus
- Ischemia or gangrene of lower extremity may complicate infusion into saphenous vein
What are the indications for arterial puncture?
- ABG sampling
- Lab sampling when venous/capillary access is limited or unobtainable
What are the contraindications for arterial puncture?
- Coagulation defects, thrombocytopenia
- Circulatory compromise in extremity
- Inappropriate artery (femoral, temporal, radial without adequate collaterals, ulnar/pedal for blood sampling)
- Infection in sampling area
- If cannulation anticipated
- CHD with shunt utilizing subclavian artery
What precautions should be taken during arterial puncture?
- Appropriate choice of artery
- Use smallest gauge needle
- Guarantee hemostasis
- Respond to and reverse arteriospasm
- Avoid brachial artery if possible
What are the neonatal considerations for arterial puncture?
- Transillumination may be helpful
- Bevel up vs bevel down
- Complete hemostasis
- Know anatomy in surrounding area
What are the complications of arterial puncture?
- Pain
- Distal ischemia
- Infection
- Hemorrhage
- Nerve damage
- Extensor tendon sheath injury
- Forearm compartment syndrome
What are the indications for peripheral arterial cannulation?
- Frequent monitoring of blood gases
- Umbilical artery unavailable
- Preductal gases required
- Direct monitoring of arterial BP when UAC unavailable or in presence of coarctation of the aorta
What are the contraindications for peripheral arterial cannulation?
- Bleeding disorder
- Inadequate collateral flow (radial)
- Circulatory insufficiency in extremity
- Local skin infection
- Malformation of extremity
What precautions should be taken during peripheral arterial cannulation?
- Allen test
- Avoid excessive hyperextension
- Leave fingertips exposed when taping
- Do not introduce air
- No rapid bolus injections
- Reverse arteriospasm
- Use for sampling only
- Remove as soon as possible
What are the complications of peripheral arterial cannulation?
- Thromboembolism/vsaspasm/thrombosis
- Blanching/loss of digits
- Gangrene/hemiplegia
- Necrosis of forearm and hand
- Skin ulcers
- Ischemia/necrosis of toes
- Occlusion of artery
- Pain
- Infiltration of infusate
- Infection
- Hematoma
- Nerve damage
- Carpal tunnel syndrome
- Hemorrhage
- Hypernatremia secondary to saline flush
- Hypervolemia
- Air embolism
What are the indications for capillary sampling?
- Routine laboratory analysis
- Newborn metabolic screen
- Blood gas analysis
What are the contraindications for capillary blood sampling?
- Poor perfusion
- Local infection
- Local edema
- Macerated skin
- Coagulation disorders
- Polycythemia
What precautions should be taken during capillary blood sampling?
- Use appropriate heel site
- Caution using heel warming device
- No scalpel blade
- Allow alcohol to dry before puncture
- Avoid excessive squeezing of foot
- Do not use fingers/toes
What are the complications of capillary blood sampling?
- Pain
- Infection
- Cellulitis
- Abscess
- Osteomyelitis
- Tissue loss/scarring
- Calcified nodules
- Inaccurate laboratory data results
What is a key consideration when performing medical procedures?
Not whether you CAN do the procedure but whether you SHOULD
Always consider whether the least invasive and least painful option is appropriate.
