Catheters are thin, flexible tubes that can be inserted into body cavities, ducts, or vessels. They are made from biocompatible materials like silicone, latex, or polymers. Catheters have various uses including draining fluids, delivering medications, or providing access for surgical instruments. Common types of catheters include urethral catheters, which drain the bladder; central venous catheters, which provide long-term intravenous access; and peripheral venous catheters for short-term intravenous access. Proper insertion and maintenance of catheters is important to provide benefits while avoiding complications like infection, injury, or blockage.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
Incepted in the year 1998, Denex International is arranged in National Capital Region (NCR) Denex International, have been effectively ready to actualize and record quality administration framework (QMS) which has been guaranteed ISO9001:2008 by International Standards Certifications (ISC) Pty. Ltd. Denex has been occupied with assembling and sending out an assortment of therapeutic disposables, which incorporates I.V. Cannula with PTFE Catheter (with wings with port, with wings without port, without wings without port) of different sizes/checks i.e. 14G, 17G, 18G, 20G, 22G, 24G, 26G
ENDOTRACHEAL TUBE INTUBATION II Parts II Details II Clinical DiscussionSwatilekha Das
What is endotracheal intubation?
Endotracheal intubation is a procedure by which a tube is inserted through the mouth down into the trachea (the large airway from the mouth to the lungs). Before surgery, this is often done under deep sedation. In emergency situations, the patient is often unconscious at the time of this procedure.
For detailed information plz watch the slides till end.......
And plz like, share and comment and follow......
indications, uses and types of cardiac catheterization, about intra cardiac pressure, about angiography and its technique, digital substraction angiography and its technique.
A cardiac event monitor is a device that you control to record the electrical activity of your heart (ECG). This device is about the size of a pager. It records your heart rate and rhythm. Cardiac event monitors are used when you need long-term monitoring of symptoms that occur less than daily
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
Incepted in the year 1998, Denex International is arranged in National Capital Region (NCR) Denex International, have been effectively ready to actualize and record quality administration framework (QMS) which has been guaranteed ISO9001:2008 by International Standards Certifications (ISC) Pty. Ltd. Denex has been occupied with assembling and sending out an assortment of therapeutic disposables, which incorporates I.V. Cannula with PTFE Catheter (with wings with port, with wings without port, without wings without port) of different sizes/checks i.e. 14G, 17G, 18G, 20G, 22G, 24G, 26G
ENDOTRACHEAL TUBE INTUBATION II Parts II Details II Clinical DiscussionSwatilekha Das
What is endotracheal intubation?
Endotracheal intubation is a procedure by which a tube is inserted through the mouth down into the trachea (the large airway from the mouth to the lungs). Before surgery, this is often done under deep sedation. In emergency situations, the patient is often unconscious at the time of this procedure.
For detailed information plz watch the slides till end.......
And plz like, share and comment and follow......
indications, uses and types of cardiac catheterization, about intra cardiac pressure, about angiography and its technique, digital substraction angiography and its technique.
A cardiac event monitor is a device that you control to record the electrical activity of your heart (ECG). This device is about the size of a pager. It records your heart rate and rhythm. Cardiac event monitors are used when you need long-term monitoring of symptoms that occur less than daily
Bladder catheters are used for urinary drainage, or as a means to collect urine for measurement.
Alternatives to indwelling urethral catheterization should be considered and include external sheath (ie, condom) catheters, suprapubic catheters, intermittent catheterization, and, in some cases, supportive management with protective garments.
Central Venous Access and Catheters. Their indications and contraindications, Different types of central catheters and their advantages and disadvantages, Technique of insertion, and Complications related to central venous lines.
This presentation was prepared by a 4th year medical student of All saints university,Dominica doing surgery rotation in milton cato memorial hospital,St.Vincent.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. Definition
• Thin flexible tube made from biomaterial
material that can be inserted into body
cavity, duct , vessel
• Allow drainage, injection of fluid, or
access to organ by surgical instrument
• Made from materials have biocompatible
properties (less likely to cause irritation
(Silicone, Latex, Polymers, Metals)
• Catheter lift inside the body either
temporarily or permanently
M.H.UOK
3. uses
• In urology (urinary catheter, folly catheter)
• In cardiology( to diagnosis and treatment of
cardiovascular disease eg coronary artery disease ,
DVT
• angioplasty, angiography,, balloon septostomy,
balloon sinuplasty, Cardiac electrophysiology……
• direct measurement of blood pressure in an artery or
vein, direct measurement of intracranial pressure
• peripheral and central venous catheter is a conduit
for giving drugs or fluids
• A Swan-Ganz catheter is a special type of catheter
placed into the pulmonary artery for measuring
M.H.UOK
6. Urinary catheterization
• direct drainage of the urinary bladder
• It may be used for diagnostic purposes (to
help determine the etiology of various
genitourinary conditions
• therapeutically (to relieve urinary retention,
instill medication, or provide irrigation)
• in-and-out procedure for immediate drainage
• left in with a self-retaining device for
short-term drainage (eg, during surgery),
• indwelling for long-term drainage for patients
with chronic urinary retention
M.H.UOK
9. Size of Foley catheter
• Charriére French scale (0.33 mm equals 1 Fr) .
• The French size of the catheter depends on the
patient and the catheter’s purpose. For example,
• pediatric boys will need a French size between
5and 12 Fr.
• Adult should be catheterized with a 16- or 18-Fr
catheter
• catheters, although a 14 Fr should be used most of
the time to facilitate comfort.
• Larger French catheters (20 to 30 Fr) are used to
evacuate blood clots in postoperative prostate
surgery patients or in patients who are bleeding
from the kidney or bladder.
M.H.UOK
10. Adults - Foley catheter (16-18 French)
Children - Foley catheter (5-12 French)
Infants younger than 6 months - Feeding
tube (5 French) with tape
Adults with gross hematuria - Catheter (20-
24 French)
M.H.UOK
11. materials
• made of various materials and are soft and
flexible
• the Robinson or straight type ,catheter is made
of rubber. Catheters can be made of pure rubber,
rubber with synthetic coatings such as latex, or
pure latex. But rubber is irritative and have
immunological response so use for short time
• in indwelling or Foley catheter made of Pure
silicone and silicone-coated, although they are
much more expensive than rubber or latex
catheters.
• Patients with latex allergies should not be
catheterized with rubber or latex catheters. In
M.H.UOK
13. Indications
• Diagnostic indications include the following:
• Collection of uncontaminated urine specimen
• Monitoring of urine output
• Imaging of the urinary tract
• Therapeutic indications include the following
• Acute urinary retention (eg, benign prostatic
hypertrophy, blood clots)
• Chronic obstruction that causes hydronephrosis
• Initiation of continuous bladder irrigation
• Intermittent decompression for neurogenic bladder
• Hygienic care of bedridden patientsM.H.UOK
14. Contraindications
• traumatic injury to the lower urinary
tract (eg, urethral tear).
• This condition may be suspected in male
patients with a pelvic or straddle-type
injury.
• Signs that increase suspicion for injury
are a high-riding or boggy prostate,
perineal hematoma, or blood at the meatus.
When any of these findings are present in
the setting of possible trauma,
• a retrograde urethrogram should be
performed to rule out a urethral tear prior
to placing a catheter into the bladder. [2]
M.H.UOK
18. • Open catheterization kit
• Prepare sterile field,
apply sterile gloves
• Check balloon for
patency.
• Generously coat the distal
portion (2-5 cm) of the
catheter with lubricant
• Apply sterile drape
procedure
M.H.UOK
19. procedure
If female, separate
labia using non-
dominant hand. If male,
hold the penis with the
non-dominant hand
perpendicular to
patient's body.
Maintain hand position
until preparing to
inflate balloon.
Using dominant hand to
handle forceps, cleanse
peri-urethral mucosa with
cleansing solution. Cleanse
anterior to posterior,
inner to outer, one swipe
per swab, discard swab away
from sterile field.
M.H.UOK
20. • Hold end of catheter loosely coiled
in palm of dominant hand.
• Identify the urinary meatus and
gently insert until 1 to 2 inches
beyond where urine is noted
• Inflate balloon, using correct
amount of sterile liquid (usually
10 cc but check actual balloon
size)
• Gently pull catheter until
inflation balloon is snug against
bladder neck
• Connect catheter to drainage system
• Secure catheter to abdomen or
thigh, without tension on tubing
• Place drainage bag below level of
bladder
procedure
M.H.UOK
21. complication
• Infections (urethritis, cystitis,
pyelonephritis, and transient bacteremia)
• Paraphimosis, caused by failure to reduce the
foreskin after catheterization
• Creation of false passages
• Urethral strictures
• Urethral perforation
• Bleeding
• Noninfectious complications accidental removal,
catheter blockage, gross hematuria, and urine
leakage,
M.H.UOK
23. central venous catheter (CVC),
• A also known as a central line, central venous line,
or central venous access catheter
• placed into a large vein in
• the neck (internal jugular vein),
• chest (subclavian vein or axillary vein),
• groin (femoral vein),
• veins in the arms )PICC line)
• The subclavian approach remains the most commonly used
• consistent landmarks, increased patient comfort, and
lower potential for infection or arterial injury
compared with other sites of access.M.H.UOK
24. indication
• intravenous access in patients requiring several
lumens for i.v. infusions and for long time
• Drugs that are prone to cause phlebitis in
peripheral veins (caustic)
• intravenous therapy when peripheral venous
access is impossible
• Hemodialysis, Plasmapheresis
• Central venous pressure monitoring
• Pulmonary artery catheterization
• Transvenous pacing wire introductionM.H.UOK
26. Contraindication
Absolute:-
1. Distorted local anatomy
2. Infection at insertion site
Relative:-
1. Presence of anticoagulation or bleeding disorder
2. Patient who is excessively underweight or overweight
3. Uncooperative patient
4. Current or possible thrombolysis
• Absolute contraindications to the subclavian approach
1. Trauma to the ipsilateral clavicle, anterior proximal rib, or
subclavian vessels
2. Coagulopathy
• Relative contraindications to the subclavian approach :
1. Chest-wall deformity
2. Chronic obstructive pulmonary disease (COPD)M.H.UOK
33. Approach
•There are two way to
subclavian vein cannulation
1- infraclavicular approach
2- supraclavicular approach
M.H.UOK
34. Approach
The index finger
of the non
dominate hand on
sternal notch
and thumb on
midclavicular
pointInsert needle 1-
2cm inferior to
junction of
proximal and
middle third of
clavicle
M.H.UOK
37. Approach
The needle hold
in 5-10 degree
anterior to
coronal plane of
the body
Directed toward
contralateral
nipple
M.H.UOK
38. Patient Preparation
• Place the patient in the supine position.
If possible, the bed should be raised to a
height that is comfortable for the operator
• Do not place towels between the shoulder
blades or turn the head; these have been
shown to decrease the size of the
subclavian vein
• Place the patient in 15º of
Trendelenburg position to reduce
the risk of air embolism
M.H.UOK
44. complication
• Lacerating or puncturing the subclavian artery
• Hematoma, pneumothorax, hemothorax
• Catheter-related thrombosis may lead to pulmonary
embolism.
• air embolism may be caused by negative intrathoracic
pressure, with inspiration by the patient drawing
air into an open line hub
• Dysrhythmia may occur as a consequence of cardiac
irritation by the wire or catheter tip
• Atrial wall puncture can lead to pericardial
tamponade.
• Bloodstream infections
• Misplacement
M.H.UOK
49. indication
• IV administration of fluid, medications,
chemotherapy ,nutritional support, blood or blood
products, radiologic contrast agents for (CT),
(MRI), or nuclear imaging
• Repeated blood sampling
contraindication
• No absolute contraindications for IV cannulation
exist
• Peripheral venous access in an injured, infected,
or burned extremity should be avoided if possible.
• Some vesicant and irritant solutions (pH <5, pH
>9, or osmolarity >600 mOsm/L) can cause
blistering and tissue necrosis if they leak into
M.H.UOK
51. Adjuncts for Finding a
Vein
• Patients often have nonvisible and nonpalpable
veins
• common method of increasing venous distention
is to ask patients to open and close their
fist.
• Lowering the arm below the level of the heart
• Light tapping can likewise be effective,
although heavy tapping may cause the vein to
spasm.
• heat packs can be applied for 10 to 20 minutes
to increase venous engorgement. This is
particularly useful in the pediatric
population.M.H.UOK
balloon septostomy:- is the widening of a foramen ovale, patent foramen ovale (PFO), or atrial septal defect (ASD) via cardiac catheterization (heart cath) using a balloon catheter. This procedure allows a greater amount of oxygenated blood to enter the systemic circulation in some cases of cyanotic congenital heart defect
balloon sinuplasty:- use for the treatment of blocked sinuses
Bladder irrigation can be defined as a process of flushing out or washing out the urinary bladder with specified solution
- Straight:- These catheters are designed for one-time use, hence the term in-and-out catheter
- Coudé catheters:- have a bend at the distal tip that causes the catheter to follow the anterior surface of the male urethra. This bent tip facilitates the insertion of the catheter in patients
with false passages, which typically occur on the posterior surface of the urethra
- The Foley catheter is designed to remain in place in the bladder. inflatable balloon, keep the catheter seated in the bladder, The flared end of the catheter is located at the distal end and can be attached to a drainage bag., The two sizes of Foley catheter balloons are 5 and 30 mL. The most commonly used is 5 mL, and it is typically inflated with 10 mL of sterile water, which accounts for the lumen volume and the balloon volume; 30-mL balloons are used to ensure that the Foley catheter does not migrate into the prostatic fossa or out of the urinary bladder altogether. In addition, the 30-mL balloon can be inflated with 50 mL
- These sizes are slightly stiffer and will follow the anatomic curvature of the male urethra easier and better than smaller French catheters (14 Fr or smaller). Smaller French catheters have a tendency to turn around in the male urethra if the slightest resistance is met (especially at the bladder neck).
Other material use
Silver alloy
Antibiotic-impregnated
Foley catheters are contraindicated in the presence of urethral trauma. Urethral injuries may occur in patients with multisystem injuries and pelvic factures, as well as straddle impacts. If this is suspected, one must perform a genital and rectal exam first. If one finds blood at the meatus of the urethra, a scrotal hematoma, a pelvic fracture, or a high riding prostate then a high suspicion of urethral tear is present. One must then perform retrograde urethrography
1- Long-term intravenous antibiotics, parenteral nutrition, especially in chronically ill persons, pain medications, Chemotherapy, Frequent or persistent requirement for intravenous access , Frequent blood draws
2- caustic drugs:- Calcium chloride, Chemotherapy, Hypertonic saline, Potassium chloride (KCl), Amiodarone Vasopressors (for example, epinephrine, dopamine)
Transvenous cardiac pacing:- intervention used primarily to correct profound bradycardia. It can be used to treat symptomatic bradycardias that do not respond to transcutaneous pacing or to drug therapy( drugs like atropine or sympathomimetic drugs (epinephrine or dopamine). Transvenous pacing is achieved by threading a pacing electrode through a vein into the right atrium, right ventricle,
(eg, vascular injury, prior surgery, radiation history)
(direct pressure to stop bleeding cannot be applied to the subclavian vein or artery, because of their location beneath the clavicle)
Equipment required for central venous access via the subclavian approach to the subclavian vein includes the following:
Central venous catheter tray (line kit)
Sterile gloves, Antiseptic solution with skin swab, Sterile drapes or towels, Sterile gown, Sterile saline flush, approximately 30 mL, Lidocaine 1% (obtain additional vial of lidocaine 1% if needed), Gauze, Dressing, Scalpel, No. 11
-Syringe with local anesthetic
-Scalpel in case venous cutdown is needed
-Sterile gel for ultrasound guidance
-Introducer needle (here 18 Ga) on syringe with saline to detect backflow of blood upon vein penetration
-Guide wire
-Tissue dilator
-Indwelling catheter (here 16 Ga)
-Additional fasteners, and corresponding surgical thread
-Dressing
1- chlorhexidine, sterile praperation
2- for local anesthesia (1inch needle)
3-use for aspiration during insertion
4-finder needle of for administrate local anesthetics, inducer needle used to cannulate vein
5-make neck in skin to allow catheter to bass through epidermins/dilator:- to create track in subcutaneous tissue for cathter
6-guidewire:- An introducer sheath can be used to introduce catheters or other devices to perform endoluminal (Seldinger technique)
7- spring loading technique
Giving them an relatively an variable anatomic position
Giving them an relatively an variable anatomic position
-Prepare the insertion site with the iodine or alcohol solution provided in the kit. This amount of preparation is often inadequate, and a wide area around the insertion site should be liberally prepared with 4 × 4 cm gauze soaked in a povidone-iodine solution
-Put on sterile mask, gown, and gloves. Drape the patient in a sterile fashion, with the insertion site exposed
1- for apply anesthetics to skin
2-for apply anesthetics to deeper tissue
3-when needle enter vessel the blood full the syringe
4-remove syringe from the needle, insert guidewire through the needle, 15cm , then remove the plastic housing and needle, keep only the guidewire
5- use 11-blade scaple to male small neck around guidewire to faceplate pass of dilator and catheter
6- Thread the dilator over the wire and into the vein with a firm and gentle twisting motion while maintaining constant control of the wire. After the introducer is inserted, hold the wire in place and remove the dilator
1- Thread the catheter over the wire until it exits the distal (brown) lumen, and grasp the wire as it exits the catheter. Continue to thread the catheter into the vein to the desired length
2-Hold the catheter in place, and remove the wire. After the wire is removed, occlude the open lumen.
3-Attach a syringe with some saline in it to the hub, and aspirate blood. Take any needed samples, and then flush the line with saline and recap. Repeat this step with all lumina.
If air embolism does occur, the patient should be placed in Trendelenburg position with a left lateral decubitus tilt, which may prevent the movement of air into the right ventricle and onward into the left side of the heart. Administration of 100% oxygen should be initiated to speed the resorption of the air. If a catheter is located in the heart, aspiration of the air should be attempted.
-. Dysrhythmia:- can usually be terminated by simply withdrawing the line into the superior vena cava. Placing a central venous catheter without a cardiac monitor is unwise.
- Bloodstream Infections :- Staphylococcus aureus and Staphylococcus epidermidis sepsis
- The narrowest catheter typically used in adults is a 22 gauge, which is sufficient for the routine administration of maintenance fluids and antibiotics.
A 20 or 18 gauge is necessary for the administration of blood products
16-gauge needle is preferred in resuscitation settings when large amounts of fluid must be given quickly
A second IV line at a different location allows additional IV line in critical resuscitations
- 18-gauge catheter in the antecubital fossa is the standard device for IV contrast–enhanced computed tomography (CT) studies such as pulmonary CT angiogram
including sclerosing solutions, some chemotherapeutic agents and vasopressors.
These solutions are more safely infused into a central vein. They should only be given through a peripheral vein in emergency situations or when a central venous access is not readily available.
1- dorsal venous arch These sites are excellent for IV therapy and comfortably accommodate 22- and 20-gauge catheters
2- The venous supply of the wrist and forearm consists of the basilic vein, which courses along the ulnar portion of the posterior aspect of the forearm. It is often ignored because of its location but can easily be accessed if the patient’s forearm is flexed and the clinician stands at the head of the patient.
3- On the radial side of the forearm, the cephalic is best known as the “intern vein.” Readily accessible, this vein can accommodate 22- to 16-gauge catheters. The median veins of the forearm course through the middle of the forearm, and the accessory cephalic veins on the radial aspect of the forearm are easily stabilized and accessible.
*- The antecubital veins consist of the medial cubital, basilic, and cephalic veins, and these veins are often selected for catheters or blood drawing. IV placement here is easy, but mobility of the arm is restricted once the catheter is in place.
-in foot dorsal digital veins, which become the dorsal metatarsal veins and form the dorsal venous arch. The arch ultimately splits into the great saphenous vein, which travels up the medial aspect of the ankle, and the small saphenous vein, which courses laterally up the opposite side
-The superficial veins of the upper extremities are preferred to those of the lower extremities for peripheral venous access because cannulation of upper-extremity veins interferes less with patient mobility and poses a lower risk for phlebitis. It is easier to insert a venous catheter where two tributaries merge into a Y-shaped form. It is recommended to choose a straight portion of a vein to minimize the chance of hitting valves
Hand veins are appropriate for 22-gauge catheters
Cephalic, accessory, or basilic veins are ideal for larger bore IV lines
The lower extremities veins can also be useful locations, especially in pediatric patients
