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2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
2013 Pediatric Subspecialty Boot Camp_Arterial access
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2013 Pediatric Subspecialty Boot Camp_Arterial access

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  • xxx00.#####.ppt 07/16/13 02:16 AM P. Text Text Text Text
  • xxx00.#####.ppt 07/16/13 02:16 AM P. Text Text Text Text
  • Thrombosis and emboli can lead to ischemia and necrosis but is dependent on adequacy of collateral flow Thrombosis longer duration and size of cath relative to arterial lumen diameter leads to greater incidence of thrombosis. Also increased incidence w/repeated punctures and intermittent flushing Emboli More common w/manual intermittent flushing Skin necrosis Prox to radial art insertion site, blood supply to to skin of distal forearm arises directly from branches of rad art. w/o ANY collateral circulation. If cath tip interferes w/these branches then ischemia to skin occurs Prevention: 1) most distal insertion site 2) smallest sized catheter so as to cause the least amt of luminal obstruction 3) prolonged catheterization xxx00.#####.ppt 07/16/13 P.
  • Brachial artery not recommended due to absence of collateral circulation xxx00.#####.ppt 07/16/13 P.
  • Palpate artery just prox to radial head Insert needle about 30 degrees to surface of skin Dorsiflex wrist for insertion then place in neutral position Suture 3-0 silk The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. xxx00.#####.ppt 07/16/13 P.
  • Hyperabducted & externally rotated 90 degrees from pt’s body Insert needle just parallel to lateral edge of pectoralis major muscle xxx00.#####.ppt 07/16/13 P.
  • Positioned similarly as for CVC 2cm below inguinal ligament 3 fingers along pulse, index/middle/ring finger, insert in between index and middle finger Insert at 45 degree angle Puncture over maximal pulsation xxx00.#####.ppt 07/16/13 P.
  • mid plantar flexion Occlude DP art  blanch toe by Compressing toenail  release pressure on nail and observe for flushing  rapid return of color indicates adequate collateral flow xxx00.#####.ppt 07/16/13 P.
  • Foot dorsiflexed xxx00.#####.ppt 07/16/13 P.
  • Transcript

    • 1. Pediatrics Vascular Access PART DEUX: Arterial Catheterization
    • 2. Page 2 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics Objectives •By the end of this workshop, the learner will be able to: ‐Recall at least 3 indications and 3 contraindications for arterial catheterization ‐Name at least 5 complications associated with arterial catheterization ‐Describe the anatomic landmarks used to guide arterial catheterization at specified sites of insertion ‐Identify the potential sites for arterial catheterization ‐Choose the appropriate sized vascular catheter according to the patient’s size
    • 3. Page 3 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics Indications •Arterial blood sampling ‐Oxygenation ‐Ventilation •Frequent blood sampling •Continuous monitoring of blood pressure
    • 4. Page 4 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics Contraindications •Known deficiencies of collateral circulation •Infection at site of insertion •Trauma injury •Coagulopathy
    • 5. Page 5 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics Complication •Arterial spasm •Thrombosis ‐Mottling proximal/distal to catheter site •Emboli •Hemorrhage ‐Axillary sheath hematoma •Infection ‐Low incidence •Skin necrosis •Fistula •Aneurysm •Brachial plexus injury
    • 6. Page 6 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics Sites of insertion •Radial/Ulnar •Axillary •Dorsalis pedis •Posterior tibial •Femoral
    • 7. Page 7 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics •Anatomy •Surface Landmarks •Positioning
    • 8. Page 8 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics Radial •Most common site •Lies in longitudinal groove formed by FCRM and distal radius •Check for collateral flow •Thrombosis is common
    • 9. Page 9 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics Axillary •Large artery •Excellent collateral flow •Air/thrombus embolism can cause brain/hand ischemia
    • 10. Page 10 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics Femoral •Also large artery •May still be palpable with marked hypotension •Lack of collateral flow •Air/thrombus embolism can cause foot/toe ischemia
    • 11. Page 11 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics Dorsalis pedis •Descends down dorsum of foot parallel & lateral to EHLT •Check for collateral flow ‐Occlude artery ‐Blanch great toe for several seconds ‐Release pressure & observe for flushing
    • 12. Page 12 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics Posterior tibial
    • 13. Page 13 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics •Confirm via pressure transduction •Tubing used for pressure monitoring should include a Luer-lock design •Papaverine-containing heparin solution prolongs arterial catheter life •If you cannot transduce……
    • 14. Page 14 xxx00.#####.ppt 07/16/13 02:16 AM Pediatrics TAKE IT OUT!!! TAKE IT OUT! TAKE IT OUT!!

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