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Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
Basic  Intravenous  Therapy 1: Anatomy
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Basic Intravenous Therapy 1: Anatomy

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Lecture presentation in Basic IV Therapy, discussion on the common IV access sites, indications, contraindications and precautions of the respective sites

Lecture presentation in Basic IV Therapy, discussion on the common IV access sites, indications, contraindications and precautions of the respective sites

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  • 1. Basic Intravenous Therapy Seminar
  • 2. Basic Intravenous Therapy Seminar
    • Anatomy: Intravenous sites
    • Pharmacology:
      • PK
      • PD
      • Drugs Reactions / Interactions
    • Fluids and Electrolytes
    • IVF’s
    • TPN
  • 3. Dr. Ronald Sanchez – Magbitang
    • EDUCATIONAL ATTAINMENT
    • NEHS
    • UST – B.S. Biology (Pre-Med)
    • SLU – Doctor of Medicine (“Emeritus”)
    • TRAININGS
    • Dr. PJGMRMC – Internal Medicine
    • Children's Medical Center – Hematology
    • RITM – 1 st In-Country Training in HIV/AIDS
    • CONVENTIONS/SYMPOSIA
    • Philippine College of Physicians
    • Philippine Association of Hospital Administrators
    • Philippine Hospital Association
    • PRESENT POSITION
    • Chief of Hospital
    • Gov. Eduardo L. Joson Memorial Hospital
    • Maharlika Highway, Daan Sarile, Cabanatuan City
  • 4.  
  • 5. BASIC INTRAVENOUS THERAPY TRAINING PROGRAM ANATOMY: Intravenous Access/Sites
  • 6. ?
  • 7. ANATOMY OF IV SITES
    • Successful cannulation:
      • proper site selection of IV access sites
      • knowledge of the gross anatomy of a vein .
  • 8.
    • General Concepts
    • The identification of the optimal site involves both visual and tactile exploration
    • The vein may be visible as a blue-green subcutaneous structure
    • It may “pop out” as it engorges with blood or merely be palpable as a springy canal coursing between the soft tissues
  • 9.
    • Given the wide variation in anatomic location of superificial veins, purely "blind" attempts , without visual or palpable landmarks, are highly unlikely to be successful and should be discouraged except in emergent situations
  • 10.
    • Ideally target a good sized vein with a straight segment at least the length of the catheter. For elective placement, site consideration should include:
      • Ease of access
      • Use of the non-dominant extremity
      • Avoiding joint areas
      • Avoiding use of the lower extremities
      • Contraindications for other sites to avoid.
  • 11.
    • ANATOMY OF THE VEIN
    • Veins are thin walled-structures that lack the thick, circumferential smooth muscular layer that is present in arteries
    • Peripheral veins may collapse and may be difficult to cannulate (or even locate) in patients with hypovolemia, low blood pressure, etc.
  • 12.  
  • 13. The Venous System From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008
  • 14.
    • Venous return to the heart is dependent upon contraction of regional skeletal muscle (e.g. the gastrocnemius and soleus in the lower leg)
    • Additionally, many veins contain valves that prevent retrograde flow of blood
    • ( Moore, KL)
    • If the intravenous catheter abuts one of these valves, flow of intravenous solution may be occluded. (Similiarly, valves can interfere with phlebotomy)
  • 15. Upper Extremity
    • In most situations, intravenous catheters are inserted in the:
      • Antecubital fossa
      • Forearm
      • Wrist
      • Dorsum of the hand
  • 16.
    • The three main veins of the antecubital fossa that are frequently used:
      • Cephalic
      • Basilic
      • Median cubital
    • These veins are usually large, easy to find, and accomodating of larger IV catheters
  • 17.  
  • 18. Veins of the upper extremity, showing the dorsal venous network of the hand as well as the palmar venous network , including the basilic and cephalic veins of the forearm From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008
  • 19. Veins of the arm: the basilic and cephalic veins From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008
  • 20.
    • Cannulation of the cephalic, basilic, or other unnamed veins of the forearm is preferrable
    • They are ideal sites when large amounts of fluids must be administered
    • Their location in a flexor region is a drawback, as bending of the elbow can be uncomfortable to the patient and may occlude the flow of the intravenous solution.
  • 21.
    • The veins in the dorsal hand may be utilized if large bore access (18 gauge or larger) is not required
    • Care must be taken to find a vein that is straight and will accept the entire length of the catheter.
  • 22.  
  • 23.
    • The portion of the cephalic vein in the region of the radial styloid is commonly known as the
    • "student's" or "intern's" vein
    • It is often a large, straight vein that is easy to cannulate
  • 24. Veins of the upper extremity, showing the dorsal venous network of the hand as well as the palmar venous network , including the basilic and cephalic veins of the forearm From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008
  • 25. Lower Extremity
    • Cannulation of the veins of the feet is not ideal !!!
    • Insertion can be quite painful, and the catheter may cause more discomfort than if it were started in the hand or forearm
    • Additionally, IV catheters placed in the feet are more likely to become infected, to not flow properly, and are more likely to produce phlebitis.
  • 26.
    • Veins of the Foot:
      • Great saphenous vein
        • runs anteriorly to the medial malleolus, and may be accessed via a peripheral venous cutdown in emergent situations
      • Lesser saphenous vein
        • runs along the lateral aspect of the foot
    • These two veins converge medially to form the dorsal venous arch . There are numerous unnamed vessels that are branches of these veins
    • (Clemente)
    • Any vein in the foot large enough to accept the IV catheter may be used if necessary.
  • 27.  
  • 28. Veins of the lower limb, demonstrating the veins of the dorsal venous arch of the foot and the great saphenous vein From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008
  • 29.
    • External Jugular
    • The external jugular ("EJ") vein can be cannulated if necessary
    • It originates near the angle of the mandible, and courses over the sternocleidomastiod muscle
    • Proximal to the clavicle, the EJ dives into the subcutaneous tissue, eventually emptying into the subclavian vein
    • (Moore)
  • 30.  
  • 31. Anatomy of the head and neck, showing the external jugular vein From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008
  • 32.
    • The EJ is a large vein that can accomodate a large bore IV catheter (18 gauge or larger), in most patients
    • It is especially useful in patients with poor access in the arms who require a large volume of fluid
    • Additionally, the EJ is often engorged in patients with heart failure and provides an alternative in these patients if other venous access sites are not available
  • 33. Scalp Veins Veins of the scalp as well as the vasculature, facial nerve, and lymphatics of the face From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008
  • 34. Indications:
    • IV access is usually needed for anesthesia care, laboring patients, trauma patients, hospital inpatients, and patient care requiring any of the following:
      • Emergency administration of medications
      • Fluid resuscitation
      • Administration of blood products
      • Elective administration of intravenous antibiotics, chemotherapeutic agents, or other treatments
      • Administration of diagnostic substances, such as methylene blue, indocyanine green, indigo carmine, or intravenous contrast agents
    • Patients donating blood products
  • 35. Contraindications:
    • Absolute Contraindications
      • None
    • Relative Contraindications
      • Avoid extremities that have massive edema, burns, or injury; in these cases other IV sites need to be accessed.
      • Avoid going through an area of cellulitis; the area of infection should not be punctured with a needle because of the risk of inoculating deeper tissue or the bloodstream with bacteria.
      • Avoid extremities with an indwelling fistula; it is preferable to place the IV in another extremity because of changes in vascular flow secondary to the fistula.
  • 36.
    • Relative Contraindications
      • An upper extremity on the same side of a mastectomy should be avoided, particularly if an axillary node dissection was carried out, because of concerns of previous lymphatic system damage and adequate lymphatic flow.
      • Very short procedures performed on pediatric patients, like placement of ear tubes
      • Bleeding diathesis
      • Medication administration that will take longer than 6 days (preference is then for a peripherally inserted central catheter)
      • Type of fluid to be administered through peripheral IV is too caustic; hypertonic solutions and some therapeutic agents should not be infused in a peripheral IV.
  • 37. Complications:
    • Common Complications
      • Inability to identify a vein for catheter placement
      • Failing to get a “flash” once the catheter is inserted
      • A flash appears, but there is no further blood flow.
      • Failing to thread the catheter into a vein after the needle is retracted
      • Infiltration; remove the catheter and apply pressure
      • Kinking of the catheter; usually the catheter must be removed
  • 38.
    • Infrequent Complications
      • Difficult IV access
      • Minor bleeding
      • Infection
        • Localized site infection
        • Cellulitis
        • Superficial thrombophlebitis
  • 39.
    • Serious and/or Rare Complications
      • Infiltration of a caustic material, such as a chemotherapeutic agents or Pentothal , which can lead to severe pain, tissue irritation, vasospasm, necrosis, and sloughing of tissues
      • Abscess formation
      • Catheter-related bacteremia
      • Bacterial endocarditis
  • 40.  
  • 41.  
  • 42. Dr. Ronald Sanchez - Magbitang Thank You !

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