Iv therapy 2008

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iv cannulation useful tips

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Iv therapy 2008

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

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