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Iv basics anatomy and physiology

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Iv basics anatomy and physiology

  1. 1. IV THERAPY - AN OVERVIEW <br />Anatomy , Physiology& Basic Concepts of IV Fluids<br />Dr.Ravindar Bethi, MD<br />Specialist , Anesthesia & ICU,<br />Al Rass General Hospital, KSA.<br />
  2. 2. IV THERAPY - AN OVERVIEW <br />Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein.<br />
  3. 3. IV THERAPY - AN OVERVIEW <br />Compared with other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body.<br />
  4. 4. IV THERAPY - AN OVERVIEW <br />Neat and clear diagram needed<br />It is commonly referred to as a drip because it employs a <br />drip chamber, <br />which prevents <br />air entering the blood stream <br />(air embolism) <br />and allows an estimate of <br />flow rate.<br />
  5. 5. FLUIDS AND <br />ELECTROLYTES<br />IV THERAPY - AN OVERVIEW <br />More clear pictures needed<br />ANATOMY AND PHYSIOLOGY<br />
  6. 6. ANATOMY AND PHYSIOLOGY<br />See ACLS print out material for text and pictures<br />Dorsal venous arch<br />
  7. 7. ANATOMY AND PHYSIOLOGY<br />Basilic vein<br />
  8. 8. ANATOMY AND PHYSIOLOGY<br />Cephalic vein<br />
  9. 9. ANATOMY AND PHYSIOLOGY<br />dorsal veins of forearm<br />
  10. 10. ANATOMY AND PHYSIOLOGY<br />
  11. 11. ANATOMY AND PHYSIOLOGY<br />Medial cubital vein<br />
  12. 12. ANATOMY AND PHYSIOLOGY<br />Brachial artery<br />Medial cubital vein<br />
  13. 13. Brachial artery<br />Medial cubital vein<br />Median Nerve<br />ANATOMY AND PHYSIOLOGY<br />
  14. 14. Femoral Vein<br />Dorsal venous arch<br />Great Saphenous Vein<br />ANATOMY AND PHYSIOLOGY<br />
  15. 15. ANATOMY AND PHYSIOLOGY<br />Scalp Veins<br />
  16. 16. Extra-vasation pictures needed<br />…the new access site has to be proximal to the "blown" area to prevent extravasation of medications through the damaged vein…<br />
  17. 17. …for this reason it is advisable to site the first cannula at the most distal site on the vein.<br />
  18. 18. Interosseous Route <br />The only alternative in emergency that is equally reliable<br />What is next best ? <br />ACLS<br />
  19. 19. ANATOMY AND PHYSIOLOGY<br />
  20. 20. Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br />
  21. 21. Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br />
  22. 22. Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br />ADVANTAGES<br /><ul><li>Fluids irritating to peripheral veins can be given
  23. 23. Chemotherapy
  24. 24. Total parenteral nutrition
  25. 25. Medications reach the heart immediately, and are quickly distributed to the rest of the body.
  26. 26. Central venous pressure can be measured</li></li></ul><li>Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br />DISADVANTAGES<br /><ul><li>Risks of bleeding, infection, air embolism.
  27. 27. Technically difficult–
  28. 28. needs experienced clinician knowing the appropriate landmarks and/or
  29. 29. using an ultrasound probe to safely locate and enter the vein.
  30. 30. Pleura and carotid artery are at risk of damage with the potential for pneumothorax or puncture/ cannulation of the artery.</li></li></ul><li>Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br />INTERNAL JUGULAR<br /><ul><li>Nursing care
  31. 31. Be cautious with potassium</li></li></ul><li>Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br /> SUBCLAVIAN<br /><ul><li>Nursing care is easier
  32. 32. Open even in shock
  33. 33. Incompressible</li></li></ul><li>Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br />FEMORAL<br /><ul><li>Emergency situations where it is difficult to cannulate Internal jugular vein or Subclavian vein
  34. 34. High risk of infection
  35. 35. Preferred for potassium infusions</li></li></ul><li>Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br />Some more photos are to be collected and placed here<br />
  36. 36. Central Venous Line Vs Pulmonary Artery Catheter<br />
  37. 37. Some special types of<br />Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br />Peripherally inserted central catheter<br />ADVANTAGES<br /><ul><li>Safer to insert with a relatively low risk of uncontrollable bleeding </li></ul>no risks of damage to the lungs or major blood vessels.<br /><ul><li>With proper hygiene, care, can be left in place for several weeks for patients who require extended treatment.</li></li></ul><li>Some special types of<br />Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br />Peripherally inserted central catheter<br />DISADVANTAGES<br /><ul><li>Must travel through a relatively small peripheral vein which can take a less predictable course on the way to the superior vena cava . Hence, more technically difficult to place in some patients.
  38. 38. Travels through the axilla. Hence, can become kinked causing poor function.</li></li></ul><li>Some special types of<br />Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br />Tunneled Lines<br />Hickman line or Broviac catheter<br /><ul><li>“Tunneled" under the skin to emerge a short distance away. from the central vein
  39. 39. Reduced risk of infection, since bacteria from the skin surface are not able to travel directly into the vein;
  40. 40. Catheters are also made of materials that resist infection and clotting.</li></ul>A Hickman line in a <br />leukemia patient.<br /> It is tunneled under the skin to the jugular vein<br />
  41. 41. Some special types of<br />Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br />Implantable ports<br /><ul><li>Silicone rubber reservoir, implanted under the skin.
  42. 42. Medication is injected via its silicone cover, into the reservoir.
  43. 43. The cover can accept several hundreds of needle sticks during its lifetime. It is possible to leave the ports in the patient's body for years.</li></li></ul><li>Some special types of<br />Central Venous Lines<br />Central Lines flow through a catheter with its tip within a large vein, usually the <br />superior vena cava or inferior vena cava, or within the right atrium of the heart.<br />Implantable ports<br /><ul><li> Needs regular maintenance. If it is plugged a thrombus can form with the accompanying risk of embolisation
  44. 44. Commonly used for patients on long-term intermittent treatment.</li></li></ul><li>IV Fluids<br />Crystalloids<br />Colloids<br />Replace with actual photos of our hospital<br />
  45. 45. IV Fluids<br />Colloids<br />
  46. 46. IV Fluids<br />Crystalloids<br />
  47. 47. IV Fluids<br />Colloids<br /><ul><li>Contain larger insoluble molecules, such as albumen.
  48. 48. Preserve a high colloid osmotic pressure in the blood
  49. 49. Blood itself is a colloid.</li></li></ul><li>IV Fluids<br />Colloids<br />
  50. 50. IV Fluids<br />Crystalloids<br /><ul><li>Aqueous solutions of water-soluble molecules.
  51. 51. The most commonly used crystalloid fluid is normal saline=, a solution of sodium chloride at 0.9% concentration, which is close to the concentration in the blood (isotonic).
  52. 52. What is isotonic?
  53. 53. What is Iso-osmolar ?</li></li></ul><li>IV Fluids<br />Crystalloids<br />
  54. 54. IV Fluids<br />Crystalloids<br />
  55. 55. IV Fluids<br />Crystalloids<br />Replace with actual photos of our hospital<br />isotonic<br /><ul><li>Fluid of choice in multiple situations
  56. 56. Trauma
  57. 57. Metabolic alkalosis
  58. 58. Not to be given in hyperchloremic acidosis</li></li></ul><li>IV Fluids<br />Crystalloids<br />Replace with actual photos of our hospital<br />hypotonic<br />
  59. 59. IV Fluids<br />Crystalloids<br /><ul><li>Iso-osmolar , compared </li></ul> to Normal Saline<br /><ul><li>Hypotonic to </li></ul> the human cells<br /> due to Insulin<br /><ul><li>Hypertonic in insulin deficiency</li></ul>? Isotonic/ Hypotonic<br /><ul><li>Isotonic in vitro
  60. 60. Hypotonic in vivo </li></li></ul><li>IV Fluids<br />Crystalloids<br />? Isotonic/ Hypertonic ? <br />
  61. 61. IV Fluids<br />Crystalloids<br />Replace with actual photos of our hospital<br /> Nearly Isotonic<br />Contains calcium, potassium and Lactate<br /><ul><li>Don’t give in alkalosis
  62. 62. Don’t give in hyperkalemia
  63. 63. Don’t give with Blood
  64. 64. Mind its Calcium content, when giving with Mg therapy</li></li></ul><li>IV Fluids<br />Crystalloids<br />Replace with actual photos of our hospital<br /><ul><li>Don’t give potassium therapy with Dextrose containing solutions
  65. 65. When giving Dextrose containing solutions, add KCl to prevent hypokalemia
  66. 66. When giving KCl in the treatment ofhypokalemia, don’t add it to solutions containing Dextrose.</li></li></ul><li>Distribution of fluid in human body<br />Crystalloids move up to here<br />DRAW NERVE CELLS<br />PICTURE OF WATER GAMES IN WATER<br />Colloids stay here<br />
  67. 67. Risks and complications of IV THERAPY <br />Infection<br />Phlebitis<br />Infiltration and extravasation<br />Embolism<br />Fluid overload<br />Electrolyte Imbalance<br />
  68. 68. Electrolytes<br />Sodium 135 – 145 mmol/L<br />Potassium 3.5 – 5.0 mmol/L<br />Calcium 2.12 – 2.75 mmol/L <br /> ( Ionised calcium 1.0-1.3 mmol/L) <br />Magnesium 1.5 – 2.2 m Eq/L<br />Phosphorous 0.81 – 1.20 mmol/L<br />
  69. 69. Electrolytes<br />Sodium 135 – 145 mmol/L<br />Potassium 3.5 – 5.0 mmol/L<br />Calcium 2.12 – 2.75 mmol/L <br />Magnesium 1.5 – 2.2 m Eq/L<br />Phosphorous 0.81 – 1.20 mmol/L<br />Low sodium – lower osmolality<br />High sodium – higher osmolality<br />
  70. 70. Sodium 135 – 145 mmol/L<br />Potassium 3.5 – 5.0 mmol/L<br />Calcium 2.12 – 2.75 mmol/L <br /> ( Ionised calcium 1.0-1.3 mmol/L) <br />Magnesium 1.5 – 2.2 m Eq/L<br />Phosphorous 0.81 – 1.20 mmol/L<br />Electrolytes<br />More DETAILS AND MORE PICTURES needed, ABOUT ALL THE ELECTROLYTES<br />Hypokalemia<br />Hyperkalemia<br />Is it ACLS 2005?<br />
  71. 71. Hyperkalemia<br />Sodium 135 – 145 mmol/L<br />Potassium 3.5 – 5.0 mmol/L<br />Calcium 2.12 – 2.75 mmol/L <br /> ( Ionised calcium 1.0-1.3 mmol/L) <br />Magnesium 1.5 – 2.2 m Eq/L<br />Phosphorous 0.81 – 1.20 mmol/L<br />BE <br />GOOD <br />IN <br />CLINICAL<br />SKILLS<br />KEEP<br />DRUGS<br />AWAY<br /><ul><li>Bicarbonate
  72. 72. Glucose +
  73. 73. Insulin
  74. 74. Calcium
  75. 75. Sorbitol
  76. 76. Keyexalate
  77. 77. Dialysis
  78. 78. Albuterol</li></ul>More DETAILS AND MORE PICTURES needed, ABOUT ALL THE ELECTROLYTES<br />Is it ACLS 2005?<br />ACLS - 2006<br />
  79. 79. Electrolytes<br />Sodium 135 – 145 mmol/L<br />Potassium 3.5 – 5.0 mmol/L<br />Calcium 2.12 – 2.75 mmol/L <br /> ( Ionised calcium 1.0-1.3 mmol/L) <br />Magnesium 1.5 – 2.2 m Eq/L<br />Phosphorous 0.81 – 1.20 mmol/L<br />
  80. 80. EVERYTHING IS RELATED TO EVERYTHING ELSE<br />THANK YOURAVINDAR BETHI<br />

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