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.
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.
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
Intercostal drainage tube insertion is an emergency as well as planned procedure. In emergency it is a one of the life saving procedures. That's why it is important to learn the anatomy and physiology behind insertion of ICD and what should be the ideal procedure and post procedure care.
An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used in airway management.
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.
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
Intercostal drainage tube insertion is an emergency as well as planned procedure. In emergency it is a one of the life saving procedures. That's why it is important to learn the anatomy and physiology behind insertion of ICD and what should be the ideal procedure and post procedure care.
An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used in airway management.
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive treatment medicine.
Central Venous Access Devices Made Incredibly Easy!Cathy Lewis
Target audience: RNs during New Hire Orientation and nurses needing additional training on identifying, assessing, and maintaining central lines.
Developed in conjunction with subject matter experts (SMEs) from IV Team. Principles based on practice at this particular institution.
In medicine, a central venous catheter ("central line", "CVC", "central venous line" or "central venous access catheter") is a catheter placed into a large vein in the neck (internal jugular vein), chest (subclavian vein or axillary vein) or groin (femoral vein)
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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 Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. Definition
A Central Venous Catheter (CVC) is an indwelling
intravenous device that is inserted into a vein of
the central vasculature.
3. Uses
1. Difficult Peripheral Vascular Access
Ex - patients with burns, previous vein injuries (such as
IV drug use)
2. Volume Loading
Time-consuming to insert and are associated with
high complication rates.
Flow rate is determined by the calibre and length of
the catheter (Poiseuille’s law)
Shorter and greater calibre catheters delivering
greater volumes over equivalent amounts of time
4. 3. Provision of Caustic Medications or Solutions
Vasoactive medications (vasopressors or inotropes)
Irritant substances (chemotherapeutic agents,
cytotoxic drugs or high concentration solutions)
Total parenteral nutrition
5. 4. Central Venous Pressure Monitoring
The central venous pressure (CVP) is the pressure
measured in the central veins close to Right atrium.
It indicates mean right atrial pressure and is
frequently used as an estimate of right ventricular
preload.
Being used as a guide for fluid management, though
some researches suggest otherwise
(http://www.ncbi.nlm.nih.gov/pubmed/18628220)
6. 5.Repeated Blood Sampling
6. Introduction of Pacemakers or Pulmonary Artery
Catheters
7.For haemodialysis/haemofiltration - For acute and chronic
haemodialysis access
8. Contraindications .cont
Relative
1. Distorted Anatomy – Trauma, deformity, burns.
2. Infection at the Site of Access – cellulitis
3. Uncooperative patients
4. Proximal Vascular Injury
5. Bleeding disorders & anticoagulation or thrombolytic
therapy.
3% complication rate as long as there are no arterial punctures (Mumatz
et al)
Absolute contraindication for subclavian access
Ultrasound guidance is recommended
9. Types Of Central Venous Catheters
1. Non-tunneled central catheters
2. Tunneled central catheters
3. Peripherally inserted central catheters (PICC)
4. Implantable ports
10. Types Of CentralVenous Catheters.cont
Single & multi-lumen catheters are available in
all catheter types
Each lumen must be treated as a separate
catheter
11. Types Of CentralVenous Catheters.cont
Open–ended
The catheter is open at the distal tip
The catheter requires clamping before entry into the
system
Clamps are usually built into the catheter
Requires periodic flushing
12. Types Of CentralVenous Catheters.cont
Closed-ended
A valve is present at the tip of the catheter (eg.
Groshong®) or at the hub of the catheter(eg. PAS-V®)
Clamping is not required as the valve is closed except
during infusion or aspiration
13. Types Of CentralVenous Catheters.cont
Composition
Silicone
Polyurethane
Coatings
♦ Antimicrobial or antiseptic coating
♦ Heparin coating
♦ Radiopaque to confirm tip placement
14. The type of CVC inserted depends on the
Type of therapy to be administered
Length of therapy (Short term or Long term)
Previous devices and complications
Patient preference
16. Polyurethane
Single or multiple lumens
Flow varies depending on size and ID
Inserted percutaneously
Internal jugular vein
Subclavian vein
Femoral vein
17. Advantages
Easier placement, removal and replacement
Economical
Disadvantages
Highest risk of infections
Unused ports must be routinely flushed with
heparin solution and clamped
Dislodged more easily
Temporary - requires frequent exchanges
19. Internal Jugular Vein
Right side preferred-lower pleural dome and thoracic duct on
left
Trendelenburg position(10-15 degrees)
Head rotated approximately 150 to the left
At the cricoid level while palpating the carotid pulse,
introducer needle into the apex of the sternocleidomastoid-
clavicular triangle at a 30-400 angle to the skin. Aim the needle
caudally towards the patient’s ipsilateral nipple.
20. Subclavian Vein
Right side preferred
- Supine position, head neutral, arm abducted
- Trendelenburg position (10-15 degrees)
- Shoulders neutral with mild retraction
Junction of the medial and middle thirds of the clavicle.
The site of needle insertion lies about 1 cm inferior to the
clavicle allowing for the needle to pass under the clavicle.
• Needle should be parallel to skin
• Aim towards the supraclavicular notch
22. Seldinger technique
Use introducing needle to
locate vein
Wire is threaded through
the needle
Needle is removed
Skin and vessel are dilated
Catheter is placed over
the wire
Wire is removed
Catheter is secured in
place
23. Post-Catheter Placement
Aspirate blood from each port
Flush with saline or sterile water
Secure catheter with sutures
Cover with sterile dressing (tega-derm)
Obtain chest x-ray for IJ and SC lines
24. Location Advantage Disadvantage
Internal
Jugular
• Bleeding can be recognized
and controlled
• Malposition is rare
• Less risk of pneumothorax
• Risk of carotid artery puncture
• Pneumothorax is possible
Subclavian • Most comfortable for
conscious patient
• Highest risk of bleeding
• Vein is non-compressible/deep vein
• Highest risk of Pneumothorax
Femoral • Easy to find vein
• No risk of Pneumothorax
• Preferred site for
emergencies
•Highest risk of infection
• Risk of DVT
• Not good for ambulatory
patients
26. Single or multiple lumens
Used for long term therapy
Inserted surgically
Small Dacron (Polyethylene terephthalate) cuff sits in
subcutaneous tunnel facilitates anchoring of the catheter
through granulation and acts as a barrier to infection
27. Advantages
Can be left in place indefinitely (if no infection,
blockage or thrombosis)
Self-care by patient
External portion can be repaired
30. Silicone or polyurethane
Single or multi-lumen
Approximately 40-60 cm long
Used for intermediate to long term therapy
Inserted percutaneously
Basalic vein
Cephalic vein
The tip rests in the superior vena cava at the cavo-atrial junction.
31. Advantages
Can remain in place for several weeks to a year
Can be easily removed
Low infection rates
External portion can be repaired
34. long-term (months to years) single or dual chamber
“port” surgically implanted in the subcutaneous
tissue, usually in the upper chest
Single or double lumen.
Each chamber must be managed separately.
35. A non-coring point needle is required to access
the device
Unused port is flushed every 28 days with
Heparin solution
36. Advantages
Internal device, no dressing or site care
Can be permanent
Unrestricted activity
Decreased risk of infection
No external components to break
May be used as long as the device is required,
functional.
40. Acute complications
Cardiac Dysrhythmias
Due to cardiac irritation by the wire or catheter tip.
Withdraw the line into the superior vena cava.
Always use a cardiac monitor.
Haematoma formation – Arterial/Venous puncture
Mechanical injury to nearby structures
Pneumothorax/Haemothoarx
Atrial wall puncture - pericardial tamponade.
Bowel penetration, Bladder puncture, Femoral nerve
injury
Air embolus
Malposition
Lost Guide-wire
42. Air embolism
Deadly complication associated with CVC’s
Signs and Symptoms
Respiratory changes: sudden shortness of breath,
cyanosis
CVS changes: sudden onset of chest pain, ↑HR,
↓BP
CNS changes: altered neurological signs, dizziness,
confusion, loss of Consciousness
43. Management
Left lateral decubitus with head low Position (Durant
maneuver and Trendelenburg position)
Clamp the Central Venous Catheter
100% O2
Direct removal of air from the venous circulation by
aspiration from a central venous catheter in the right
atrium may be attempted
44. To minimize the chance of air entering the
system:
Ensure the lumen is clamped prior to opening the
system
Position the patient so that the insertion site is at
or below the level of the heart during insertion
and removal of catheter
45. Infections
Most frequent and serious complications.
Types
Local infection – Cellulitis
Central Line-Associated Bloodstream Infections
(CLABSI)
46. Causative Organisms
Staph epidermidis 25-50%
Staph aureus 25%
Candida 5-10%
Risk Factors
Cutaneous colonization of the insertion site
Moisture under the dressing
Prolonged catheter time
Technique of care and placement of the central
line