1) An extravasation occurs when a vesicant medication or solution is inadvertently administered into the surrounding tissues, potentially causing tissue injury. This is a common complication among neonates receiving intravenous therapies.
2) The NICU nurse plays an important role in monitoring intravenous sites for early signs of infiltration or extravasation and preventing injury. If extravasation occurs, immediate treatment is needed to minimize damage, such as stopping the infusion and applying saline compresses.
3) Proper peripheral intravenous insertion and maintenance can help prevent complications. When extravasation injury does occur, hyaluronidase may be used to help distribute the vesicant over a larger area and reduce edema, in addition to wound
The document discusses the components and goals of Pediatric Advanced Life Support (PALS). PALS involves assessing and supporting pulmonary and circulatory functions before, during, and after cardiac arrest in children. It utilizes basic life support techniques as well as advanced medical devices and pharmacological interventions. The document outlines the initial diagnosis process using ABCDE (airway, breathing, circulation, disability, exposure), as well as secondary diagnosis involving a focused history and physical exam. Key resuscitation tools like intraosseous access and bag-mask ventilation are also described. The ultimate goal of PALS is to save children's lives during medical emergencies.
This document provides guidance on pediatric advanced life support (PALS). It discusses respiratory and circulatory failure, which often lead to cardiac arrest in children. Asphyxial cardiac arrest caused by lack of oxygen is more common than primary cardiac issues. Shock is also a common precursor and progresses from compensated to decompensated states. Foreign body airway obstruction, drowning, and hypothermia/hyperthermia are covered. The document provides detailed guidance on airway management, ventilation, vascular access, defibrillation, and the management of arrhythmias like tachycardia and bradycardia in a pediatric setting.
This document provides guidelines for pediatric advanced life support (PALS). It outlines the systematic approach algorithm which begins with checking responsiveness, calling for help, and checking for a pulse. The BLS assessment evaluates consciousness, breathing, and skin color to determine if the child is unresponsive with no breathing. For infants and children under 8, CPR should be provided first before calling for help, while those over 8 receive phone assistance first before CPR. The guidelines describe performing CPR, providing oxygen, inserting airways, monitoring the child, establishing IV/IO access, administering adrenaline, and considering reversible causes and an advanced airway. The primary and secondary assessment evaluates the child's airway, breathing, circulation, and
This document discusses various inotropic drugs used to increase the contractility of the heart. It describes the mechanisms and indications for commonly used inotropes like dobutamine, dopamine, epinephrine, milrinone and digoxin. Precise dosing guidelines and dilution methods are provided for each drug. Potential side effects and nursing considerations are also summarized for safe administration of inotropic therapy.
This document discusses guidelines for intravenous fluid management for shock in pediatric patients from Dr. Udai Bhan Yadav of the General Hospital in Alwar, Rajasthan. It provides recommendations on administering IV fluids like Ringer's Lactate or normal saline for shock at doses of 20ml/kg. For severe malnutrition, IV fluids should be given at 15ml/kg over 1 hour. Guidelines are also given for IV glucose administration depending on age and weight to treat low blood sugar. Charts provide volumes of IV fluids and glucose solutions to administer based on patient age and weight.
As part of my course, I have prepared power point presentation on lumbar puncture. Books which i have referred are Sister Nancy and Poter and Perry Fundamental of nursing. I hope this ppt will be be some help to the prospect Nursing learners.
Care of patient with external ventricular drainShruti Shirke
Nurses are responsible for caring for patients with external ventricular drains (EVDs) used to treat hydrocephalus and reduce intracranial pressure. EVDs drain excess cerebrospinal fluid from the brain ventricles to an external drainage system. Nurses must carefully monitor fluid drainage and intracranial pressure, watch for signs of infection or blockage, and ensure the EVD system is properly aligned and functioning to safely manage the patient's condition.
Ventilator-associated pneumonia (VAP) is a type of hospital-acquired pneumonia that occurs in patients on mechanical ventilation. It is caused by bacteria entering the lungs through the ventilation tube or tracheostomy. VAP increases ICU and hospital stays by 4-9 days and medical costs by $40,000-$50,000 per patient. Adhering to a VAP care bundle that includes keeping patients' heads of bed elevated, daily sedation vacations, DVT prophylaxis, stress ulcer prophylaxis, and daily oral care can reduce VAP rates by up to 65%.
The document discusses the components and goals of Pediatric Advanced Life Support (PALS). PALS involves assessing and supporting pulmonary and circulatory functions before, during, and after cardiac arrest in children. It utilizes basic life support techniques as well as advanced medical devices and pharmacological interventions. The document outlines the initial diagnosis process using ABCDE (airway, breathing, circulation, disability, exposure), as well as secondary diagnosis involving a focused history and physical exam. Key resuscitation tools like intraosseous access and bag-mask ventilation are also described. The ultimate goal of PALS is to save children's lives during medical emergencies.
This document provides guidance on pediatric advanced life support (PALS). It discusses respiratory and circulatory failure, which often lead to cardiac arrest in children. Asphyxial cardiac arrest caused by lack of oxygen is more common than primary cardiac issues. Shock is also a common precursor and progresses from compensated to decompensated states. Foreign body airway obstruction, drowning, and hypothermia/hyperthermia are covered. The document provides detailed guidance on airway management, ventilation, vascular access, defibrillation, and the management of arrhythmias like tachycardia and bradycardia in a pediatric setting.
This document provides guidelines for pediatric advanced life support (PALS). It outlines the systematic approach algorithm which begins with checking responsiveness, calling for help, and checking for a pulse. The BLS assessment evaluates consciousness, breathing, and skin color to determine if the child is unresponsive with no breathing. For infants and children under 8, CPR should be provided first before calling for help, while those over 8 receive phone assistance first before CPR. The guidelines describe performing CPR, providing oxygen, inserting airways, monitoring the child, establishing IV/IO access, administering adrenaline, and considering reversible causes and an advanced airway. The primary and secondary assessment evaluates the child's airway, breathing, circulation, and
This document discusses various inotropic drugs used to increase the contractility of the heart. It describes the mechanisms and indications for commonly used inotropes like dobutamine, dopamine, epinephrine, milrinone and digoxin. Precise dosing guidelines and dilution methods are provided for each drug. Potential side effects and nursing considerations are also summarized for safe administration of inotropic therapy.
This document discusses guidelines for intravenous fluid management for shock in pediatric patients from Dr. Udai Bhan Yadav of the General Hospital in Alwar, Rajasthan. It provides recommendations on administering IV fluids like Ringer's Lactate or normal saline for shock at doses of 20ml/kg. For severe malnutrition, IV fluids should be given at 15ml/kg over 1 hour. Guidelines are also given for IV glucose administration depending on age and weight to treat low blood sugar. Charts provide volumes of IV fluids and glucose solutions to administer based on patient age and weight.
As part of my course, I have prepared power point presentation on lumbar puncture. Books which i have referred are Sister Nancy and Poter and Perry Fundamental of nursing. I hope this ppt will be be some help to the prospect Nursing learners.
Care of patient with external ventricular drainShruti Shirke
Nurses are responsible for caring for patients with external ventricular drains (EVDs) used to treat hydrocephalus and reduce intracranial pressure. EVDs drain excess cerebrospinal fluid from the brain ventricles to an external drainage system. Nurses must carefully monitor fluid drainage and intracranial pressure, watch for signs of infection or blockage, and ensure the EVD system is properly aligned and functioning to safely manage the patient's condition.
Ventilator-associated pneumonia (VAP) is a type of hospital-acquired pneumonia that occurs in patients on mechanical ventilation. It is caused by bacteria entering the lungs through the ventilation tube or tracheostomy. VAP increases ICU and hospital stays by 4-9 days and medical costs by $40,000-$50,000 per patient. Adhering to a VAP care bundle that includes keeping patients' heads of bed elevated, daily sedation vacations, DVT prophylaxis, stress ulcer prophylaxis, and daily oral care can reduce VAP rates by up to 65%.
Paediatric basic life support (PBLS) involves resuscitation procedures to prevent anoxic brain damage and promote circulation and breathing in children. The key steps of PBLS are CAB - checking for circulation (C) by feeling for a pulse, opening the airway (A), and giving rescue breaths (B). For infants and children in cardiac arrest, high-quality chest compressions at least 100/min that depress the sternum 1/3 its depth are critical, along with proper head positioning and rescue breathing. PBLS should continue for 2 minutes in cycles of 30 compressions to 2 breaths before emergency help arrives or switching rescuers.
Central venous catheterization and venous cut down techniques were presented. Central venous catheterization involves placing lines into large neck, chest, or groin veins and should only be done aseptically in operating rooms or high dependency units. It has indications for monitoring, infusing irritant drugs, pacing, dialysis, and emergencies. Sites include the subclavian, internal jugular, and femoral veins, each with advantages and disadvantages. Ultrasound guidance is becoming standard. Complications include infections, arterial puncture, and pneumothorax. Venous cut down is an open surgical technique to access veins and remains useful when other methods fail or are unavailable.
The document discusses sedation, analgesia, and paralysis in the ICU. It describes the goals of sedation as patient comfort while allowing interaction. The challenges include assessing sedation and altered drug pharmacology. An ideal sedation agent would have rapid onset and offset and lack respiratory depression. Monitoring scales like the Richmond Agitation Scale are used to standardize treatment. Dexmedetomidine, propofol, opioids and paralytics may be used. The optimal sedation approach balances adequate treatment while avoiding oversedation risks.
This document provides information on pediatric intravenous cannulation. It defines pediatric IV cannulation as inserting a cannula into a child's vein to administer medications, fluids, blood or nutrition. The document outlines indications for IV cannulation in children and discusses sites to avoid. It also describes the proper procedure for pediatric IV insertion including preparing the child, identifying appropriate veins, inserting the cannula, securing it, and documenting the process. Potential complications of improper cannulation are explained as well as a scale for assessing infusion phlebitis.
Noradrenaline is a potent vasoconstrictor used to treat profound hypotension, usually in combination with dopamine, when other inotropes have failed in sepsis patients. It is administered by IV infusion at an initial dose of 0.05-0.1 microgram/kg/minute, titrated up to a maximum of 1-1.5 microgram/kg/minute. The drug comes in 2mg/2mL ampoules and is diluted for infusion based on the baby's weight to achieve a rate of 0.1 microgram/kg/minute, administered over 24 hours and monitored for potential side effects like hypertension and local tissue damage from extravasation.
Dr. Dharmendra Joshi provides an overview of defibrillation and cardioversion. Some key points include:
- Defibrillation involves delivering unsynchronized energy during any cardiac cycle phase to terminate arrhythmias like ventricular fibrillation. Cardioversion delivers synchronized energy to large QRS complexes.
- Biphasic waveforms are now preferred over monophasic as they provide effective defibrillation at lower energies, reducing risk of injury.
- Safety is paramount, with operators announcing charges and discharges to avoid contact with patient or equipment. Complications can include arrhythmias, burns, embolism and myocardial necrosis. Troubleshooting focuses on proper equipment connection and settings.
This document discusses inotropes, which are drugs that increase the force of myocardial contraction. It defines inotropes and discusses their physiological effects and classification. Various endogenous and exogenous inotropic agents are described in detail, including their mechanisms of action, indications, dosages, pharmacokinetics and side effects. Sympathomimetic drugs like epinephrine, norepinephrine and dopamine are discussed as conventional positive inotropic agents.
1. The document describes the lumbar puncture procedure to obtain cerebrospinal fluid for mycological and virological studies.
2. Key steps of the procedure include positioning the patient on their side, prepping and draping the skin over the L3-L4 intervertebral space, administering local anesthesia, inserting a spinal needle to withdraw cerebrospinal fluid, and having the patient rest afterwards to prevent leakage from the puncture site.
3. Potential complications of a lumbar puncture include bleeding, discomfort, infection, headache, and nerve damage.
This document discusses sedation in the intensive care unit (ICU). It outlines the need for sedation to relieve anxiety, pain, and facilitate mechanical ventilation. The goals of sedation are patient comfort while controlling pain and stress responses. An ideal sedative has little respiratory depression, rapid onset/offset, allows for arousal but sedation. Commonly used sedatives include opioids like fentanyl and morphine, benzodiazepines like midazolam, and propofol. Factors like hypoxia or agitation must be addressed and not attributed solely to lack of sedation. Sedation scales standardize treatment and help prevent oversedation. A sedation holiday of stopping sedation may shorten time on
This document discusses strategies for preventing ventilator-associated pneumonia (VAP) in intubated patients. It defines VAP and reviews risk factors such as prolonged intubation. Preventative measures include following infection control guidelines, using oral antiseptics to reduce bacterial colonization, maintaining head of bed elevation and cuff pressure to prevent aspiration, and minimizing the duration of mechanical ventilation when possible. Adhering closely to bundles that incorporate these various preventative strategies can help reduce the incidence of VAP.
The document discusses guidelines for sedation, analgesia, and neuromuscular blockade in the adult ICU. It describes the benefits of daily sedation interruption and titration programs to lighten sedation levels. It provides an overview of options for sedation and analgesia, including opioids, benzodiazepines, propofol, dexmedetomidine, and neuromuscular blockade. It also addresses risks of oversedation like delirium and discusses strategies for preventing and treating delirium.
1. Intraosseous (IO) access involves inserting a needle into the bone marrow cavity to provide vascular access for fluid or drug administration when intravenous access is not possible.
2. IO access was first reported in 1922 and is now widely accepted for use in both children and adults with difficult venous access. It provides a reliable route for drug delivery similar to intravenous administration.
3. IO access has several advantages over other emergency vascular access methods in that it is quick to perform, effective, can be used at multiple insertion sites, and has fewer complications than a central venous catheter.
This document discusses intravenous (IV) fluid therapy. It begins by introducing the components of solutions like water and solutes, and the functions of water in the body including transport, waste elimination, and temperature regulation. It then discusses fluid balance, the thirst mechanism, and fluid gains and losses. The document outlines the purposes of IV fluid regulation including rehydration and medication administration. It describes identifying dehydration and types of IV fluids available like crystalloids and colloids. It concludes with nursing considerations for different fluid types and complications of IV fluid treatment.
Precautions for Central Venous Catheters in NeonatesKing_maged
Includes: different methods of venous access, CDC guidelines for prevention of catheter-related infections as well as precautions for umbilical catheters use .. Prepared by Dr. Maged Zakaria, NICU Resident, Ain-Shams University Maternity Hospital
CPAP provides continuous positive airway pressure throughout the respiratory cycle to keep alveoli open and increase functional residual capacity in the lungs, improving gas exchange. It has a long history dating back to the 1970s and is commonly used for conditions that decrease functional residual capacity like RDS, apnea of prematurity, and BPD. CPAP is administered non-invasively via the nasal route using prongs, masks, or cannulae attached to a flow generator. It has physiological benefits like improved oxygenation and ventilation. Complications can include pneumothorax, nasal trauma, and gastric distension which are generally preventable with proper application and monitoring.
The document provides guidelines for performing basic cardiac life support, including how to recognize cardiac arrest, provide chest compressions and rescue breathing, assess for breathing and pulse, and properly position victims. It also covers foreign body airway obstruction for both conscious and unconscious adult, child, and infant victims, with steps for back blows, chest thrusts, and CPR. The chain of survival and importance of early defibrillation, emergency medical services activation, and high-quality CPR is emphasized.
Neonatal resuscitation 2015 aha guidelines update for cprChandan Gowda
The 2015 AHA Neonatal Resuscitation Guidelines update provides recommendations for several changes:
1. Positive pressure ventilation for preterm infants should include PEEP of 5cmH2O. Laryngeal masks are recommended when intubation is not feasible for infants >34 weeks.
2. Initiation of resuscitation for preterm infants should use low oxygen (21-30%) titrated to target saturation rather than high oxygen. Term infants should be initiated with room air.
3. Chest compressions are indicated if the heart rate is <60/minute despite ventilation. The 2-thumb technique is preferred for compressions.
4. Assessment of heart rate response is the best measure
Central and PICC Line: Care and Best Practices Mary Larson
This document provides information and best practices for central and peripherally inserted central catheter (PICC) lines. It discusses indications for central lines, types of central lines including non-tunneled and PICC lines. Proper catheter dressing changes and flushing are outlined, including using chlorhexidine to cleanse the skin and flushing with saline before and after each use. Assessment of catheter sites and documentation standards are also reviewed.
The key to a successful Acute Pain Service is not so much the use of sophisticated drugs and high technology equipment, but an excellent organisational structure and well trained medical and nursing personnel.
An extravasation occurs when a vesicant solution is inadvertently administered into surrounding tissue instead of the vein. Signs and symptoms include pain, swelling, skin tightness, and discoloration at the IV site. Initial signs may be subtle but can progress to skin necrosis, blistering, and permanent damage if not properly managed. To manage an extravasation, the infusion must be stopped immediately, the drug withdrawn from the cannula, and the limb elevated. Further treatment depends on the drug involved and extent of damage. Proper training, assessment of competence, and documentation are important for preventing extravasation complications.
1) The document discusses a presentation given by clinical librarians to medical staff about finding medical evidence in the neonatal intensive care unit.
2) It provides an overview of library services available from both hospital and university libraries and how to access full text articles off-site using the proxy server.
3) The presentation demonstrates how to effectively search PubMed, including using clinical queries and filters, to find relevant research studies to answer clinical questions.
Paediatric basic life support (PBLS) involves resuscitation procedures to prevent anoxic brain damage and promote circulation and breathing in children. The key steps of PBLS are CAB - checking for circulation (C) by feeling for a pulse, opening the airway (A), and giving rescue breaths (B). For infants and children in cardiac arrest, high-quality chest compressions at least 100/min that depress the sternum 1/3 its depth are critical, along with proper head positioning and rescue breathing. PBLS should continue for 2 minutes in cycles of 30 compressions to 2 breaths before emergency help arrives or switching rescuers.
Central venous catheterization and venous cut down techniques were presented. Central venous catheterization involves placing lines into large neck, chest, or groin veins and should only be done aseptically in operating rooms or high dependency units. It has indications for monitoring, infusing irritant drugs, pacing, dialysis, and emergencies. Sites include the subclavian, internal jugular, and femoral veins, each with advantages and disadvantages. Ultrasound guidance is becoming standard. Complications include infections, arterial puncture, and pneumothorax. Venous cut down is an open surgical technique to access veins and remains useful when other methods fail or are unavailable.
The document discusses sedation, analgesia, and paralysis in the ICU. It describes the goals of sedation as patient comfort while allowing interaction. The challenges include assessing sedation and altered drug pharmacology. An ideal sedation agent would have rapid onset and offset and lack respiratory depression. Monitoring scales like the Richmond Agitation Scale are used to standardize treatment. Dexmedetomidine, propofol, opioids and paralytics may be used. The optimal sedation approach balances adequate treatment while avoiding oversedation risks.
This document provides information on pediatric intravenous cannulation. It defines pediatric IV cannulation as inserting a cannula into a child's vein to administer medications, fluids, blood or nutrition. The document outlines indications for IV cannulation in children and discusses sites to avoid. It also describes the proper procedure for pediatric IV insertion including preparing the child, identifying appropriate veins, inserting the cannula, securing it, and documenting the process. Potential complications of improper cannulation are explained as well as a scale for assessing infusion phlebitis.
Noradrenaline is a potent vasoconstrictor used to treat profound hypotension, usually in combination with dopamine, when other inotropes have failed in sepsis patients. It is administered by IV infusion at an initial dose of 0.05-0.1 microgram/kg/minute, titrated up to a maximum of 1-1.5 microgram/kg/minute. The drug comes in 2mg/2mL ampoules and is diluted for infusion based on the baby's weight to achieve a rate of 0.1 microgram/kg/minute, administered over 24 hours and monitored for potential side effects like hypertension and local tissue damage from extravasation.
Dr. Dharmendra Joshi provides an overview of defibrillation and cardioversion. Some key points include:
- Defibrillation involves delivering unsynchronized energy during any cardiac cycle phase to terminate arrhythmias like ventricular fibrillation. Cardioversion delivers synchronized energy to large QRS complexes.
- Biphasic waveforms are now preferred over monophasic as they provide effective defibrillation at lower energies, reducing risk of injury.
- Safety is paramount, with operators announcing charges and discharges to avoid contact with patient or equipment. Complications can include arrhythmias, burns, embolism and myocardial necrosis. Troubleshooting focuses on proper equipment connection and settings.
This document discusses inotropes, which are drugs that increase the force of myocardial contraction. It defines inotropes and discusses their physiological effects and classification. Various endogenous and exogenous inotropic agents are described in detail, including their mechanisms of action, indications, dosages, pharmacokinetics and side effects. Sympathomimetic drugs like epinephrine, norepinephrine and dopamine are discussed as conventional positive inotropic agents.
1. The document describes the lumbar puncture procedure to obtain cerebrospinal fluid for mycological and virological studies.
2. Key steps of the procedure include positioning the patient on their side, prepping and draping the skin over the L3-L4 intervertebral space, administering local anesthesia, inserting a spinal needle to withdraw cerebrospinal fluid, and having the patient rest afterwards to prevent leakage from the puncture site.
3. Potential complications of a lumbar puncture include bleeding, discomfort, infection, headache, and nerve damage.
This document discusses sedation in the intensive care unit (ICU). It outlines the need for sedation to relieve anxiety, pain, and facilitate mechanical ventilation. The goals of sedation are patient comfort while controlling pain and stress responses. An ideal sedative has little respiratory depression, rapid onset/offset, allows for arousal but sedation. Commonly used sedatives include opioids like fentanyl and morphine, benzodiazepines like midazolam, and propofol. Factors like hypoxia or agitation must be addressed and not attributed solely to lack of sedation. Sedation scales standardize treatment and help prevent oversedation. A sedation holiday of stopping sedation may shorten time on
This document discusses strategies for preventing ventilator-associated pneumonia (VAP) in intubated patients. It defines VAP and reviews risk factors such as prolonged intubation. Preventative measures include following infection control guidelines, using oral antiseptics to reduce bacterial colonization, maintaining head of bed elevation and cuff pressure to prevent aspiration, and minimizing the duration of mechanical ventilation when possible. Adhering closely to bundles that incorporate these various preventative strategies can help reduce the incidence of VAP.
The document discusses guidelines for sedation, analgesia, and neuromuscular blockade in the adult ICU. It describes the benefits of daily sedation interruption and titration programs to lighten sedation levels. It provides an overview of options for sedation and analgesia, including opioids, benzodiazepines, propofol, dexmedetomidine, and neuromuscular blockade. It also addresses risks of oversedation like delirium and discusses strategies for preventing and treating delirium.
1. Intraosseous (IO) access involves inserting a needle into the bone marrow cavity to provide vascular access for fluid or drug administration when intravenous access is not possible.
2. IO access was first reported in 1922 and is now widely accepted for use in both children and adults with difficult venous access. It provides a reliable route for drug delivery similar to intravenous administration.
3. IO access has several advantages over other emergency vascular access methods in that it is quick to perform, effective, can be used at multiple insertion sites, and has fewer complications than a central venous catheter.
This document discusses intravenous (IV) fluid therapy. It begins by introducing the components of solutions like water and solutes, and the functions of water in the body including transport, waste elimination, and temperature regulation. It then discusses fluid balance, the thirst mechanism, and fluid gains and losses. The document outlines the purposes of IV fluid regulation including rehydration and medication administration. It describes identifying dehydration and types of IV fluids available like crystalloids and colloids. It concludes with nursing considerations for different fluid types and complications of IV fluid treatment.
Precautions for Central Venous Catheters in NeonatesKing_maged
Includes: different methods of venous access, CDC guidelines for prevention of catheter-related infections as well as precautions for umbilical catheters use .. Prepared by Dr. Maged Zakaria, NICU Resident, Ain-Shams University Maternity Hospital
CPAP provides continuous positive airway pressure throughout the respiratory cycle to keep alveoli open and increase functional residual capacity in the lungs, improving gas exchange. It has a long history dating back to the 1970s and is commonly used for conditions that decrease functional residual capacity like RDS, apnea of prematurity, and BPD. CPAP is administered non-invasively via the nasal route using prongs, masks, or cannulae attached to a flow generator. It has physiological benefits like improved oxygenation and ventilation. Complications can include pneumothorax, nasal trauma, and gastric distension which are generally preventable with proper application and monitoring.
The document provides guidelines for performing basic cardiac life support, including how to recognize cardiac arrest, provide chest compressions and rescue breathing, assess for breathing and pulse, and properly position victims. It also covers foreign body airway obstruction for both conscious and unconscious adult, child, and infant victims, with steps for back blows, chest thrusts, and CPR. The chain of survival and importance of early defibrillation, emergency medical services activation, and high-quality CPR is emphasized.
Neonatal resuscitation 2015 aha guidelines update for cprChandan Gowda
The 2015 AHA Neonatal Resuscitation Guidelines update provides recommendations for several changes:
1. Positive pressure ventilation for preterm infants should include PEEP of 5cmH2O. Laryngeal masks are recommended when intubation is not feasible for infants >34 weeks.
2. Initiation of resuscitation for preterm infants should use low oxygen (21-30%) titrated to target saturation rather than high oxygen. Term infants should be initiated with room air.
3. Chest compressions are indicated if the heart rate is <60/minute despite ventilation. The 2-thumb technique is preferred for compressions.
4. Assessment of heart rate response is the best measure
Central and PICC Line: Care and Best Practices Mary Larson
This document provides information and best practices for central and peripherally inserted central catheter (PICC) lines. It discusses indications for central lines, types of central lines including non-tunneled and PICC lines. Proper catheter dressing changes and flushing are outlined, including using chlorhexidine to cleanse the skin and flushing with saline before and after each use. Assessment of catheter sites and documentation standards are also reviewed.
The key to a successful Acute Pain Service is not so much the use of sophisticated drugs and high technology equipment, but an excellent organisational structure and well trained medical and nursing personnel.
An extravasation occurs when a vesicant solution is inadvertently administered into surrounding tissue instead of the vein. Signs and symptoms include pain, swelling, skin tightness, and discoloration at the IV site. Initial signs may be subtle but can progress to skin necrosis, blistering, and permanent damage if not properly managed. To manage an extravasation, the infusion must be stopped immediately, the drug withdrawn from the cannula, and the limb elevated. Further treatment depends on the drug involved and extent of damage. Proper training, assessment of competence, and documentation are important for preventing extravasation complications.
1) The document discusses a presentation given by clinical librarians to medical staff about finding medical evidence in the neonatal intensive care unit.
2) It provides an overview of library services available from both hospital and university libraries and how to access full text articles off-site using the proxy server.
3) The presentation demonstrates how to effectively search PubMed, including using clinical queries and filters, to find relevant research studies to answer clinical questions.
This document provides guidance on performing a newborn examination. It begins by classifying newborns by gestational age and birth weight. It then describes how to assess vital signs, growth measurements, and the different body systems. Key parts of the examination are classified including the skin, head, eyes, chest, heart, abdomen, genitals and nervous system. Important reflexes are outlined to assess neurological development. The document emphasizes the importance of estimating gestational age and recognizing normal and abnormal findings during the newborn examination.
This document provides an outline for a basic neonatology course. It includes:
1. Seven intended learning outcomes covering topics like job description, components of the NICU, common cases, and history taking.
2. Descriptions of the resident's job, components of the NICU, most common cases, and how to take a patient history.
3. Suggested complementary topics like fluid balance, procedures, and normal lab values to learn.
The document provides an overview of common neonatal problems experienced in the first 24 hours and first week of life. It discusses minor problems such as vernix caseosa, erythema neonatorum, acrocyanosis, breast engorgement, Erb's palsy, physiologic jaundice, weight loss, periodic breathing, vomiting, failure to pass urine/meconium, bowel patterns and constipation. It also discusses conditions like dehydration fever, jitteriness, conjunctivitis, nasolacrimal duct obstruction, umbilical sepsis, excessive crying, evening colic, vaginal bleeding, urate crystals in urine, subconjunctival hemorrhage, umbilical her
This document provides guidelines for assessing the health of a newborn infant. It describes evaluating the infant's history including prenatal and delivery factors. Physical appearance is assessed including skin, tone, head size and overall appearance. Vital signs like temperature, heart rate, respiratory rate and status are examined. Laboratory tests including arterial and capillary blood samples are outlined. Gestational age assessment tools like the Dubowitz Scale and Ballard Scale are presented. Proper technique for obtaining capillary blood samples is also covered.
- Birth trauma can cause scalp injuries like caput succedaneum, subgaleal hematoma, and cephalohematoma. Skull fractures including linear, depressed, and occipital osteodiastasis fractures can also occur.
- The most serious complication is intracranial hemorrhage which can present as epidural hematoma, subdural hematoma, subarachnoid hemorrhage, or intraparenchymal hematoma.
- Risk factors include macrosomia, breech presentation, and forceps or vacuum assisted delivery. Imaging like CT is important to evaluate skull fractures and hemorrhages, while management depends on severity and symptoms.
Scleroderma is a multisystem collagen vascular disease characterized by fibrosis of the skin and involvement of internal organs. It can be classified as diffuse or localized systemic sclerosis. Common manifestations include pulmonary fibrosis, esophageal dysmotility causing reflux, delayed gastric emptying, and small bowel involvement seen as "hidebound sign". Skeletal involvement causes acro-osteolysis, joint space narrowing, and flexion deformities of the hands.
This document outlines various danger signs in newborns that require prompt medical attention. It discusses signs like lethargy, poor feeding, prolonged capillary refill time, respiratory distress, hypothermia, cyanosis, vomiting, diarrhea, failure to pass urine or meconium, abnormal weight loss, and signs that could indicate conditions like cardiac disease or tracheo-esophageal fistula. Early detection and treatment of sick newborns is important to prevent high mortality, but diagnosis can be difficult due to non-specific signs, especially in preterm or low birth weight babies. Proper assessment of danger signs and timely referral is necessary to care for newborns with illnesses.
Neonatal respiratory diseases can present as respiratory distress in newborns, characterized by tachypnea, grunting, chest wall indrawing, and cyanosis. Common causes include respiratory distress syndrome (lack of surfactant), pneumonia, meconium aspiration syndrome, and congenital diaphragmatic hernia. Respiratory distress syndrome is treated with supportive care like oxygen supplementation or CPAP, and may require mechanical ventilation. Pneumonia is usually treated with antibiotics and oxygen as needed. Meconium aspiration syndrome can cause lung injury and inflammation requiring oxygen, antibiotics, and steroids. Congenital diaphragmatic hernia presents with respiratory distress at birth due to lung compression, and is
This document contains details from several mock OSCE stations assessing medical students.
Station 23 involves counselling a 15-year-old boy with a BMI of 36 about obesity, diet, exercise, comorbidities, and encouraging positive behavior changes. Station 24 involves taking a thorough medical history from the mother of a child with short stature. Station 25 demonstrates the motor examination of a child's right arm. Station 26 continues resuscitation of a newborn with clear amniotic fluid that did not breathe spontaneously at birth. Station 27 counsels the mother of a 1-year-old boy with breath holding spells. Station 28 involves taking anthropometric measurements of a child and calculating BMI and another index. Station 29 counsels
This presentation aims at discussion of the pathophysiology , clinical presentation and management of the different types of intracranial bleeds in a neonate. Special emphasis has been laid on intraventricular hemorrhage. The germinal matrix bleed in a preterm is discussed in depth along with the various evidence based management protocols available. Radiological diagnosis of IVH in a preterm / term baby will be discussed in the upcoming presentations.
Toxic shock syndrome is a life-threatening illness caused by toxins from Staphylococcus aureus or Streptococcus pyogenes bacteria. It causes high fever, low blood pressure, rash, and problems affecting multiple organ systems. While often associated with tampon use, it can result from other infections as well. Prompt treatment includes antibiotics, IV fluids, and organ support. Nurses closely monitor patients and management includes infection control, fluid resuscitation, and prevention of recurrence.
Facial soft tissue injuries require careful examination and treatment due to the aesthetic and functional importance of the face. Key areas to inspect for injuries include the nasal septum, ears, eyes, and underlying structures. Injuries are classified by type such as contusions, abrasions, lacerations, and avulsions. Proper cleaning, debridement when needed, and primary closure within 24 hours helps reduce risks of infection and improve cosmetic results. Special considerations apply to repairing injuries around sensitive areas like the eyes, nose, ears, and lips.
Systemic sclerosis, or scleroderma, is a multisystem disorder characterized by vascular abnormalities, skin and organ fibrosis, and immune system activation. It can be classified as either diffuse or limited cutaneous systemic sclerosis based on the extent and pattern of skin involvement. Common clinical features include Raynaud's phenomenon, skin thickening, gastrointestinal issues, lung fibrosis, and renal crisis. Treatment involves managing symptoms, with immunosuppressants sometimes used to modify disease progression. Prognosis depends on subtype, with limited scleroderma carrying a better long-term survival rate than diffuse disease.
This document discusses pediatric femoral neck fractures. Key points:
- They are rare, accounting for less than 1% of pediatric fractures. Anatomy and blood supply make complications like avascular necrosis more common.
- Delbet classification includes 4 types based on fracture location. Type 1 is through the physis, Type 2 through the neck, Type 3 at the base of neck, and Type 4 is intertrochanteric.
- Treatment depends on type and stability but generally involves closed or open reduction and fixation or spica casting. Complications include avascular necrosis, coxa vara, premature physeal closure, and nonunion. Close follow up is needed due to risk of late complications.
This document discusses several common postnatal and neonatal problems, including:
1) Congenital diaphragmatic hernia, which causes profound respiratory distress in 1 in 5,000 live births.
2) Ureteropelvic junction obstruction, which is often detected incidentally and can be corrected by pyeloplasty.
3) Gastroschisis, which is diagnosed prenatally and carries risks of short bowel syndrome.
This document discusses respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD). RDS is caused by surfactant deficiency in preterm infants and affects lung development and function. Key points include:
- RDS incidence is inversely related to gestational age and birth weight, peaking at 24-48 hours of life.
- Surfactant deficiency leads to atelectasis, decreased lung compliance, increased work of breathing and hypoxemia.
- Surfactant is normally produced by type II alveolar cells starting around 24 weeks gestation and is essential for reducing surface tension in the lungs.
This document discusses premature babies and respiratory distress in newborns. It defines a premature baby as one born before 37 weeks of gestation. Respiratory distress is common in extremely premature infants, especially those born before 28 weeks. Causes of respiratory distress include respiratory distress syndrome, meconium aspiration, transient tachypnea of the newborn, and pneumonia. Risk factors include low gestational age, low birth weight, and maternal diabetes. The document describes several scoring systems used to evaluate the severity of respiratory distress in newborns. Treatment involves oxygen supplementation, corticosteroids to accelerate lung maturation, surfactant replacement therapies, and nutrition support.
The document outlines an analysis of Pakistan's Expanded Programme on Immunization (EPI) with the objectives of reviewing its social and poverty impacts, intended and unintended consequences on different groups, and factors that help or hinder its targeted impact. It discusses gaps in existing literature on EPI in Pakistan and proposes a methodology using quantitative and qualitative methods like descriptive analysis, econometric estimations, social impact analysis, and stakeholder interviews. An institutional analysis identifies fragmentation across different government bodies related to EPI. The document also performs a SWOT analysis of the EPI program and discusses budgetary considerations.
This document discusses IV infiltration and extravasation. It defines these terms and describes signs and symptoms. It outlines categories of infiltration and extravasation and explains prevention, management, and treatment. Precautions are discussed for peripheral and central lines. High risk patients and detection methods are covered. General treatment includes stopping the infusion, aspirating residual drug, elevating the limb, and applying compresses. Management of specific non-chemo drug extravasations is also reviewed. The conclusion emphasizes the importance of prevention and successful treatment to avoid injury.
This document defines intravenous infusion and outlines its purpose, types, equipment, procedures, documentation, calculations, factors affecting rate, site care, and complications. IV therapy is used to prevent or treat fluid/electrolyte imbalances when oral intake is not possible. It involves introducing fluids intravenously. The nurse is responsible for initiation, monitoring, and discontinuation. Common types include isotonic, hypotonic, and hypertonic solutions. Careful documentation and monitoring for complications like infiltration and infection is important when providing IV therapy.
This document provides guidance on vascular access procedures for pediatric patients. It discusses:
1) The importance of rapid vascular access for fluid resuscitation and drug administration during emergencies. Intraosseous access should be prioritized if IV access cannot be quickly achieved.
2) Procedures for establishing intraosseous, peripheral, central, and femoral venous access.
3) The importance of following universal precautions during all vascular access procedures.
This document provides information about intravenous (IV) access including indications, types of IV access, IV administration sets, cannulas, and considerations for successful IV placement. It discusses peripheral and central venous access, as well as PICC lines. It describes sets for fluid and blood administration and how to confirm proper IV placement. It also outlines complications including infiltration, arterial placement, air embolism, catheter fracture, infection, thrombophlebitis, and needlestick injuries. Proper patient positioning, gathering supplies, predicting difficult access, using vasodilation techniques, and universal precautions are emphasized for successful IV access.
This document provides guidance on inserting a peripheral intravenous cannula. It describes the equipment needed, vein selection, insertion procedure, documentation, and potential complications. The aim is to safely deliver treatment without discomfort or tissue damage while maintaining venous access. Proper preparation, aseptic technique, and site care are emphasized to prevent infections and other complications.
1. This document provides guidance on inserting intravenous (IV) catheters and minimizing risks of complications.
2. Only trained nurses may insert IV catheters, except for patients under 14 where a medical practitioner is required. A maximum of 3 attempts should be made before seeking help.
3. Proper vein selection, insertion technique, and aseptic preparation are emphasized to reduce risks of phlebitis, thrombophlebitis, infiltration, hematoma, and infection. Systemic complications like septicemia and air embolism are also addressed.
1. There are three main types of vascular access for hemodialysis in children: tunneled catheters, arteriovenous fistulas, and arteriovenous grafts.
2. It is important to educate children with declining kidney function about their vascular access options and the importance of vein preservation for potential future access.
3. The choice of vascular access depends on multiple patient-specific factors and a dedicated vascular access clinic can help increase use of arteriovenous fistulas and decrease use of catheters.
This document provides information on intraosseous vascular access. It discusses indications for IO insertion including cardiac arrest, deteriorating patient, trauma, and inability to obtain IV access. It reviews safe insertion of the EZ-IO needle including equipment, sites, and steps. Potential risks and complications are outlined. Drugs and fluids that can be administered via IO are noted. Practical tips are provided such as pushing fluids due to resistance. Patient safety tips emphasize obtaining definitive venous access when possible and removing the IO.
This document discusses intravenous fluid therapy. It begins by introducing intravenous infusion and outlining its purposes, which include providing fluids when oral intake is not possible due to factors like unconsciousness, surgery, or vomiting. The document then covers components of fluid therapy like maintenance and replacement, body fluid requirements by age, types of IV solutions like isotonic and hypertonic, and steps for setting up and maintaining IV therapy. Potential complications of IV therapy like infiltration and phlebitis are also summarized.
This document discusses intravenous (IV) therapy, complications that can arise, and best practices for prevention. It notes that 85% of hospitalized patients receive IV therapy, with 118 million catheters inserted yearly. Complications include phlebitis, infiltration, extravasation, and infection. Proper catheter and site selection, sterile technique, and regular site inspection can help prevent complications. Infection is a serious risk, with over 60,000 deaths annually from bloodstream infections related to IV therapy in the US.
A cannula is a flexible tube that can be inserted into the body for medical purposes. There are different types of cannulas including intravenous and nasal cannulas. Cannulas are commonly used for repeated blood sampling, intravenous fluid administration, medications, chemotherapy, nutrition, blood/blood products, and contrast agents. The procedure for cannulation involves introducing oneself to the patient, explaining the procedure, selecting an appropriate vein such as those in the forearm or hand, cleaning the site, inserting the cannula bevel up at a 30 degree angle, securing it, and avoiding certain sites that could cause complications like infiltration, extravasation, thrombosis, cellulitis, or phlebitis.
Intramuscular, intravenous, and intra-arterial cannulation techniques are described. Intramuscular injections deliver medication into large muscles and became popular after World War II. Intravenous cannulation involves inserting a cannula into a vein to deliver fluids or medications and potential complications include extravasation, hematoma, and infection. Intra-arterial cannulation is used for invasive arterial blood pressure monitoring and involves inserting a catheter into an artery like the radial artery. Potential complications of intra-arterial cannulation include thrombosis and pseudoaneurysm.
The document outlines guidelines for inserting intravenous cannulas including:
1. Only nurses certified in IV insertion will perform the procedure, or medical practitioners for patients under 14.
2. If insertion fails after two attempts by a nurse, a third attempt can be made or a medical practitioner will assist.
3. Proper vein selection, preparation, insertion technique and post-insertion care are described to minimize complications of IV therapy.
INTRAVENOUS FLUID THERAPY jsvsb with babban mbsvkstAshishS82
This document provides information on intravenous fluid therapy including its purposes, types of IV fluids, methods of IV administration, and potential complications. The main purposes of IV therapy are to restore fluid volume lost from the body, meet patients' basic hydration and nutritional needs, prevent and treat shock, and administer medications. The three types of IV fluids are isotonic, hypotonic, and hypertonic solutions. Common methods of IV administration include large volume infusions, IV boluses, piggyback infusions, and mini infusion pumps. Potential complications include circulatory overload, infiltration, thrombophlebitis, infection, and air embolism. Careful monitoring of infusion rates and the patient's condition can help prevent complications.
1) Blunt abdominal trauma is injury to the abdomen from non-penetrating forces and is a common cause of injury from motor vehicle accidents. 2) Presentation can vary widely from hemodynamic stability with minimal signs to complete shock. Common injuries include injuries to solid organs like the spleen and liver as well as hollow organs. 3) Initial assessment focuses on the ABCDEs with attention to potential for internal bleeding and hemorrhagic shock. History and physical exam aim to identify any signs of intra-abdominal injury.
1) Blunt abdominal trauma is injury to the abdomen from non-penetrating forces and is a common cause of injury from motor vehicle accidents. Symptoms can range from minimal signs to cardiovascular collapse.
2) The spleen, liver, and kidneys are most commonly injured in blunt trauma due to their solid nature. Injuries to hollow organs like the stomach and intestines also occur from shearing forces.
3) Initial assessment focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure. Patients are fully evaluated and stabilized, with two IV lines placed and fluid resuscitation started if indicated. Ongoing monitoring of vitals and input/output is important
complications in the late postoperative period..shanmugham karthick raja 225B...KarthickRaja424180
The document discusses complications that can occur in the late postoperative period. It covers various phases of recovery from immediate to after discharge. Common causes of postoperative fever are then examined for each day following surgery. The aim of the first two phases is discussed as well as factors considered when a patient can leave the recovery room. A variety of general postoperative problems are then outlined such as pain, fluids and nutrition, nausea and vomiting, and bleeding. Specific issues like hypothermia, infection, drains, wound care and dehiscence are also summarized. Respiratory complications including pneumonia, pulmonary embolism and atelectasis are additionally covered.
The document provides information on setting up and demonstrating intravenous (IV) fluid therapy. It defines IV therapy as the infusion of fluids, medications, blood or blood products directly into a vein. The document outlines guidelines for IV therapy including following physician orders, maintaining aseptic technique, and monitoring for complications. It also demonstrates the correct technique for IV injection including assessing the patient, preparing equipment, inserting the IV cannula, setting the drip rate, and disposing of supplies properly. Short answer questions assess understanding of IV fluid types, indications, advantages, and calculations for setting drip rates.
This document discusses infiltration and extravasation which are complications of intravenous (IV) therapy. Infiltration occurs when IV fluid leaks into surrounding tissue due to improper catheter placement or dislodgement. Extravasation is when vesicant (toxic) drugs leak into tissue. Both can cause swelling, pain, and tissue damage. To prevent these complications, health care providers should select appropriate IV sites, use proper insertion technique, securely fix catheters, and monitor sites frequently. If complications occur, the IV should be removed and the site elevated, documented, and further treated based on symptoms and severity.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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2. • Many medications given to neonates have the
potential to injure when an extravasation
occurs.
• An extravasation is described by the Infusion
Nurses Society (INS) as the inadvertent
administration of a vesicant solution or
medication into the surrounding tissues.[1]
3. A vesicant
is defined as a solution or medication that causes
the formation of blisters leading to tissue
necrosis and sloughing.
4. Extravasation
Inadvertent administration of vesicant
medication or solution into the surrounding
tissue.
Infiltration
the inadvertent administration of non-
vesicant medication or solution into the
surrounding tissue.
5. Interstitial
• Any type of fluid in the interstitial space or
the space between tissue layers and outside
of the vein
Occlusion
Blockage that stops the passage of infusate or
normal saline flush into the lumen.Often
accompanied by an increase in pressure
reading on the IV pump.
6. Infiltration Is Common Among Neonates
• The peripheral intravenous (PIV) catheter is the
most used vascular access device for the
administration of medications in hospitalized
neonates; however 95% of PIV catheters are
removed due to complications such as leaking,
occlusion and infiltration.[4]
• Infiltration rates among neonates are as high as
57%–70% with extravasation occurring in 11–
23%.[5] Both infiltration and extravasation are
destructive
7.
8.
9.
10. • Extravasations have the potential to cause
peripheral tissue injury depending on the type
of vesicant, concentration of the vesicant,
location, amount, and duration of exposure to
the vesicant.
• Damage from a vesicant may progress over
time and become evident 48–72 hours after
the extravasation occurs.
11. The preterm and sick neonate is more
susceptible to skin injury and complications
from extravasation injury than their mature,
healthy counterparts.
• Their immature skin structures,
• flexible subcutaneous tissue,
• small blood vessels and poor venous integrity
increase the risk of complication from
venipuncture and IV infusions.[5,8]
12. • The goal in neonatal care is to prevent skin
breakdown whenever possible. Similarly,
attention to thermoregulation, pain and stress
that infants endure as a result of repeated IV
attempts or restarts, and infiltrations and
extravasations must be considered and
managed
13. Inflammation in the Premature Infant
• The neonatal immune system is poorly
regulated compared to adults and
dysregulation is magnified when neonates are
born early.[11-13] While intravenous therapy is
necessary in this population, it is not without
its risks.
14. • Vesicants can harm the endothelial lining of
the blood vessel, triggering production and
release of oxygen free radicals that spur
inflammation.[14,
15. • which is common in prematurity, or the
inflammatory assault is severe, endothelial
dysfunction leads to programmed cell death
(apoptosis).[16]
• The load of oxidative stress in premature infants
is especially of concern as it has been linked to
various neonatal morbidities including
necrotizing enterocolitis,[16,17] retinopathy of
prematurity,[18-20] and chronic lung disease.[16,21-
23]
17. The Neonatal Intensive Care Unit
(NICU) Nurse's Role
• NICU nurses monitor the PIV site with
vigilance to aid in early identification of
infiltration and extravasation and prevent this
type of injury whenever possible. Identifying
an infiltration may be difficult, even for the
most experienced nurse.[10]
18. • The NICU nurse is aware of the subtle changes
in heart rate, oxygen saturations, apnea, and
the more obvious change in behavior such
crying and agitation that may indicate
problems with the PIV therapy.[4
19. Potential Origins of Infiltration
• There is a supposition that an infiltration or
extravasation is caused by IV catheter dislodgement or
puncture of the vein during insertion or during
handling of the infant.
• Chemical composition of medications also impacts risk
of vein rupture.[5]
• The vein's tolerance to an infusion is affected by the
osmolality and pH of the vesicant, the duration of the
exposure, and irritation to the endothelial cells.[4]
• An additional factor in causing a cannulated vessel to
rupture and leak is the pressure in which the
medication is being delivered by the infusion pump.[3,5]
20. Irritants and Vesicants Given to
Neonates
• ntravenous medications can be divided into
three major subcategories: 1) non-vesicants,
2) irritants, and 3) vesicants. In order for an
infiltration to be a true extravasation, the
offending agent, by definition, must be a
vesicant. There are a number of different
qualities that affect the potential for a
medication to result in tissue damage. These
include, but are not limited to: osmolarity, pH,
direct medication effects and solubility.[27]
21. • ntravenous medications can be divided into
three major subcategories: 1) non-vesicants,
2) irritants, and 3) vesicants. In order for an
infiltration to be a true extravasation, the
offending agent, by definition, must be a
vesicant. There are a number of different
qualities that affect the potential for a
medication to result in tissue damage. These
include, but are not limited to: osmolarity, pH,
direct medication effects and solubility.[27]
22.
23. Nursing Actions to Prevent Vascular
Injury
• The best method to decrease complications of PIV
therapy is to prevent them in the first place.[2]
• Serious complications are not entirely preventable, but
following recommended standards of IV therapy is the
best approach for avoiding complications.[3]
• The decision to place a peripherally inserted central
catheters (PICC) or central venous lines (CVL) might be
needed if vascular access is difficult or long-term
parenteral therapy is planned. However
24. Recommendations for Practice to
Prevent Vascular Injury.
Peripheral IV Insertion and Maintenance
Use small enough plastic/silicone catheter to avoid restriction of blood flow
Avoid repeated use of a vein
Avoid placing a PIV in an areas difficult to immobilize
Use transparent tape to secure
Cover the site with a sterile semi-permeable transparent dressing that will permit
ongoing visualization of the insertion site
Upper extremities less likely to infiltrate or leak compared with peripheral IV in
lower extremities or scalp veins
Place tape loosely over boney prominences to avoid restricting blood flow to the
extremity
Infusion Maintenance
Limit PIV glucose to 12.5%
Dilute medications as much as possible before administration are other solutions
25.
26.
27. Key Actions to Minimize Injury When
Extravasation Occurs
• Once an infiltration or extravasation is
discovered, immediate treatment is the key to
preventing progressive damage from the
vesicant.[2]
• Treatment decisions are based on the size and
appearance of the injury, type of IV infusing,
duration of exposure and location.[8] Protocols
and algorithms can be used to assist nurses in the
steps needed to minimize the potential damage
and start the treatment process.
28. • Stopping the infusion and elevation of the extremity is
the first actions followed by placement of a saline
soaked gauze or prepackaged normal saline pad.
• The saline draws out the vesicant, and impedes a scab
from forming to allow fluid to leak out.
• Gently squeezing the fluid from the open insertion site
can also help to remove the offensive agent.[8] While
the saline soaks are held in place, assistance with the
various tasks that are required for treatment may
require additional personnel.
29. • Documentation:
Following an IV insertion, document the
following information in the patient record:
Date and time of procedure.
Gauge and type of access device used.
Site of insertion.
Patient’s tolerance of the procedure.
type of solution, additives and rate of
infusion
•
30. Wound care
• Cleansing:
· Normal saline. Any wound swabs should only be taken after cleansing.
• Moisture and autolytic debridement:
· Water-based wound gel (hydrogel).
• Protection and Absorption:
· An absorptive layer such as Aquacel® can be placed directly over the
wound to prevent
any dressing from sticking to the wound and to absorb necrotic material as
it softens.
· Cover with a hydrocolloid or clear acrylic dressing. A thin product
conforms better with
infant’s small limbs. Use only enough to give approximately a 1 cm border
around the
• Assess dressings a minimum of q4h and prn for integrity and drainage.
31. • Replace dressing q 7 days or PRN if the dressing being saturated
with exudate or is lifting
significantly. A hydrocolloid will have a “swiss cheese” appearance
when saturated. If the
edges begin to lift they can be reinforced with a transparent
dressing.
• If there are signs of systemic sepsis such as fever or temperature
instability etc, or local
inflammation around the area of the wound, remove the dressing
and assess for wound infection
evidenced by purulent drainage and peri-wound erethema. Send
wound swab after cleansing the
wound bed with saline and consult wound and skin assessment
team for a dressing protocol for an
infected wound.
32. • Saline Flush Technique:
This procedure involves making
small puncture marks around the
edge of the area of extravasation
and the inserting a cannula into each
of the puncture sites in turn and
flushing normal saline through each
puncture site. The volume in the
literature is 500 mls, although this
should be modified down in the
neonate. The goal is that the flush
solution will exit out of the other
puncture site.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42. Hyaluronidase
• Hyaluronidase is an enzyme that breaks down
hyaluronic acid, a compound best described as the
"glue" which holds cells together. When this
extracellular glue is dissolved, cells are separated. This
is helpful in extravasations as it allows for the
medication to distribute through a larger area by
breaking down the walls that keep it localized. This not
only helps to decrease the concentration effects of the
extravasated product, but also exposes the medication
to more capillary beds that allows for reduction of
edema via more rapid reabsorption and removal of the
product from the damaged area.
43. Phentolamine
• Phentolamine is an antidote that will counteract the effect of
vasoactive agents such as dopamine, epinephrine, norepinephrine
and phenylephrine.[8] These medications result in vasoconstriction
via stimulation of alpha-receptors.
• Phentolamine acts to block the activity of alpha-receptors and
subsequently will help relax vascular smooth muscle. This will
improve circulation in the area of the extravasation and thus
decrease ischemia and cell death. Phentolamine can also be utilized
for vasopressin or dopamine extravasation.[28]Phentolamine should
be administered within 12 hours of initial exposure but
administration should occur as soon as possible. Prepare a 0.5 to 1
mg/mL solution and administer 0.1 mg/kg (to a max of 2.5 mg in
neonates,
44. • Nitroglycerin Ointment (2%)
• Nitroglycerin 2% is an option to treat extravasations.[8]Nitroglycerin
acts to relax smooth muscle resulting in arteriolar, arterial and
venous vasodilation that results in increased capillary blood flow,
counteracting the effects of vasoactive medications. This will help
to reverse tissue ischemia and cell death. In the neonatal
population, there is a case report describing the use of 1 inch of 2%
nitroglycerin ointment for treatment of a dopamine extravasation,
located in the dorsum of the left hand, in a 1.8 kg 34 week preemie.
This resulted in return of circulation within a few minutes. Of note,
treatment was started almost 12 hours after the extravasation was
initially noted and patient had no significant change in
hemodynamics.[33]
45.
46. References
• References
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