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Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
Iv therapy 2008
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Iv therapy 2008

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iv cannulation useful tips

iv cannulation useful tips

Published in: Health & Medicine
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  • 1. IV Therapy Anatomy & Physiology
    • Dr Manjit George
    • Anaesthetics
  • 2. Anatomy
    • Upper limb veins
    • Basilic vein
    • Cephalic vein
    • Median cubital vein
    • Lower limb veins
    • Femoral vein
    • Saphenous vein
  • 3. Anatomy
  • 4.  
  • 5. Structure of vessels
    • Arteries - smooth muscles
    • Clinical application- cold, nerve blocks
    • Arterioles - tiny branches of arteries that lead to capillaries
    • Controlled by Sympathetic Nervous System
    • constrict & dilate to regulate blood flow
  • 6. Structure of vessels
    • Veins - Walls consist of 3 layers of tissues thinner and less elastic than the corresponding layers of arteries
    • Valves aid return of blood to the heart by preventing blood flowing in the reverse direction
  • 7. Structure of vessels
    • Capillaries - tiny blood vessels(approx 5-20 microns in diameter)
    • Walls are only one cell thick
    • permits exchanges of material between them & the surrounding tissue
    • Venules- minute vessels that drain blood from capillaries into veins
    • Many venules unite to form a vein
  • 8. Artery v/s Vein
    • Away from heart
    • Oxgenated blood
    • Narrow lumen
    • More muscle/elastic tissue
    • High pressure
    • Towards the heart
    • Deoxygenated blood
    • Wide lumen
    • Less muscle /elastic tissue
    • Low pressure
  • 9. Physiology
    • Superficial veins are not paired with an artery unlike deep veins
    • Superficial veins are important physiologically for cooling of the body
    • Not as important as deep veins as they carry less blood
  • 10. Physiology
    • Poiseuille’s Law
    • Flow rate F = P1 – P2
    • __ _____ =
    • R
    • (pressure difference) (radius) 4
    • _______________________
    • 8(viscosity) (length)
  • 11. Determinants of flow rate
    • Viscosity of infusing fluid
    • Length of the plastic cannula tube
    • The diameter of the tube (gauge size)
    • size 24 - 19mm long, 0.7 diam,flow rate -22ml/min size 14 - 50mm long, 2.2 diam, flow rate 343ml/min
    • Pressure of infusion (pressure bags)
    • Blood pressure of the patient
  • 12. Clinical patho physiology
    • Varicose veins
    • Venous ulcers
    • Arterialisation of veins – AV fistula
  • 13. A “good” vein
    • One that is not kinked
    • One that is clearly visible
    • One that is easily palpable
    • “ Forked” veins where 2 tributaries come together
  • 14. Unsuitable veins
    • Tortuous veins
    • Flexor aspect of the wrist (risk of radial.n damage)
    • Veins above the elbow joint- median cubital vein
    • Veins over bony prominences
    • Dorsum of hand in the elderly except when they are prominent & well filled
    • Avoid patients dominant arm, if possible
    • Areas over mobile joints/ areas of flexion
    • Limbs with fractures/ a-v shunts
  • 15. Difficult venous access
    • Obese
    • Extremes of age
    • Grossly oedematous states- hypoalbuminemia
    • Burns
    • IV Drug Abusers
    • Malignancy- Oncology patients
    • Sickle cell anaemia
  • 16. Practical issues
    • Indication ?
    • Site ?
    • Rate of infusion ?
    • Choice of cannula size ?
    • Duration ?
    • Protocols ?
  • 17. Venflons- infusion rates
    • 14 G- 343ml/min
    • 16 G- 220 ml/ min
    • 18 G- 120 ml/min
    • 20 G- 80ml/min
    • 22 G- 40 ml/min
    • 24 G- 22ml/min
  • 18. Complications
    • Pain/ fear
    • Bruising/ Haematoma
    • Thrombophlebitis
    • Injury to nerve/artery
    • Subcutaneous infiltration
    • Cellulitis
  • 19. Practical tips
    • Visual / tactile senses, good lighting
    • Start distally
    • Dependant position (below heart level)
    • Tourniquet/ BP cuff inflated to 70-80 mm Hg
    • Tapping/ opening and closing of fist
    • Local application of warmth/ warm towel
    • Correct size of venflon
    • Hair/ sweat
    • EMLA cream(1 hour), Ametop (20 mins), Lignocaine 1%

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