An intracatheter is a plastic tube inserted into a blood vessel. They were first used in 1929 when a surgeon inserted a catheter into his own heart. There are several types including peripheral, central venous, and pulmonary artery catheters. They are made of biocompatible polymers like polyurethane and silicone. Size is determined by gauge or French units, with smaller gauges and French sizes indicating thinner catheters. Complications can include infection, infiltration of fluids, thrombosis, and air embolism. Larger central venous catheters are often needed for critically ill patients requiring multiple therapies.
Incepted in the year 1998, Denex International is arranged in National Capital Region (NCR) Denex International, have been effectively ready to actualize and record quality administration framework (QMS) which has been guaranteed ISO9001:2008 by International Standards Certifications (ISC) Pty. Ltd. Denex has been occupied with assembling and sending out an assortment of therapeutic disposables, which incorporates I.V. Cannula with PTFE Catheter (with wings with port, with wings without port, without wings without port) of different sizes/checks i.e. 14G, 17G, 18G, 20G, 22G, 24G, 26G
Injections, also known as shots, deliver liquid medications, fluids, or nutrients directly into a person’s body. A healthcare professional can use injections to administer vaccines and other types of medications into a person’s vein, muscle, skin, or bone.
Incepted in the year 1998, Denex International is arranged in National Capital Region (NCR) Denex International, have been effectively ready to actualize and record quality administration framework (QMS) which has been guaranteed ISO9001:2008 by International Standards Certifications (ISC) Pty. Ltd. Denex has been occupied with assembling and sending out an assortment of therapeutic disposables, which incorporates I.V. Cannula with PTFE Catheter (with wings with port, with wings without port, without wings without port) of different sizes/checks i.e. 14G, 17G, 18G, 20G, 22G, 24G, 26G
Injections, also known as shots, deliver liquid medications, fluids, or nutrients directly into a person’s body. A healthcare professional can use injections to administer vaccines and other types of medications into a person’s vein, muscle, skin, or bone.
Lecture presentation in Basic IV Therapy, discussion on the common IV access sites, indications, contraindications and precautions of the respective sites
This slideshow introduces the basic concepts around intravenous cannulation. Whilst the context is midwifery this slideshow is also suitable for nurses and medical staff.
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.
Iv fluid therapy (types, indications, doses calculation)kholeif
All what you need to know intravenous fluids, types, indications, contraindications, how to calculate fluid rate and drug dosages.
Embed code (http://www.slideshare.net/slideshow/embed_code/16138690)
Sharir Kriya Instuments By Prof.Dr.R.R.Deshpande –
Sharir Kriya ( Ayurvedic Physiology) is Basic subject of First BAMS ( Ayurvedic Graduation).This PPT is very useful as a Teaching Aid for Ayurvedic Teachers & useful Assets for Learning to Ayurveda students.PPT covers all Important Instruments like Microscopes, Stethascope ,BP Apparatus,Haemocytometer,Neubaur’s chamber,Tunning fork,Clinical Hammer,Urinometer,Hepende’s caliper to measure skin fold thickness,ECG Machine,Thermometer,Nasal Speculum,ESR Tubes & Stands,Ryle’s tube,Autoscope,Vaginal Speculum,Proctoscope,Tonometer etc.Another interesting part is you will get Introduction to useful Books & web site Links of Prof.Dr.R.R.Deshpande .Visit – www.ayurvedicfriend.com
Introducing a volunteer mentoring program - Deanna Lynn Cole ivolunteer Unive...Deanna Cole, CVA
Introducing a volunteer mentoring program
By Deanna Lynn Cole
www.ivolunteerUNIVERSITY.com
When engaging volunteers it can be difficult to ensure that each volunteer receives the time, attention, and training that they need to be successful - this is where a volunteer mentoring program can help! Mentoring improves success in volunteer placement, increases recruiting and retention rates, engages seasoned volunteers and creates a sustainable practice for your organization. By encouraging a learning culture through mentoring, you can ensure that volunteers take an active role in spreading knowledge and best practices throughout their organization. In the first part of this two-part session, you'll learn how a mentoring program can benefit your volunteer engagement program and your organization, and some key steps and best practices for creating a mentoring program. Part II will cover building and managing a team of volunteer mentors. While it is strongly encouraged and extremely beneficial to attend both Part I and Part II of this series, attending both is not required.
What You'll Learn:
How a volunteer mentor program can positively impact a volunteer engagement program.
The benefits of mentoring to volunteers and the organization.
How to structure a mentoring program.
Best practices for introducing a volunteer mentoring program into an organization.
Who Should Attend:
Volunteer Program Managers
Those responsible for managing or engaging volunteers
FMI contact Deanna Lynn Cole at ivolunteerUNIVERSITY@gmail.com
Dr. Somendra shukla is a one of the best Pediatrician & neonatologist in Gurgaon. He has vast expierence of 9 yrs in neonatology & pediatrics. He has cleared the prestigious Diplomate of National Board (DNB) and royal college of pediatrics, ondon (MRCPCH) examinations in pediatrics. He has worked and honed up her skills with some of the top corporates institutes of India such as Fortis hospital, moolchand medcity and paras hospital. He has also done his Fellowship in neonatology awarded by prestigious National neonatology forum of India.
He is a member of IAP and NNF and has attended various seminars and workshops and has presented several papers in various national conferences and conducted CMEs.
He is an expert in newborn intensive care including care of ventilated and extremely low birth weight babies (<1000g><750g). He has also been trained in cranial Ultrasonography and Echo studies in neonates.
Dr. Somendra shukla is a one of the best Pediatrician & neonatologist at Gurgaon.
He has vast expierence of 9 yrs in neonatology & pediatrics. He has cleared the prestigious Diplomate of National Board (DNB) and royal college of pediatrics, london (MRCPCH) examinations in pediatrics. He has worked and honed up her skills with some of the top corporates institutes of India such as Fortis hospital, moolchand medcity and paras hospital. He has also done his Fellowship in neonatology awarded by prestigious National neonatology forum of India.He is a member of IAP and NNF and has attended various seminars and workshops and has presented several papers in various national conferences and conducted CMEs. He is an expert in newborn intensive care including care of ventilated and extremely low birth weight babies (<1000g><750g). His area of interest are childhood vaccination, growth and development and childhood asthma.
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)
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.
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
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
3. History
3
1929 when a 25 year old surgical resident
named Werner Forssman inserted a plastic
urethral catheter into the basilic vein in his
right arm and then advanced the catheter into
the right atrium of his heart.
in 1956 Forssman was awarded the Nobel
Prize in Medicine for performing the first right-
heart catheterization in a human subject.
4. Types
4
Peripheral vascular catheters
• Venous
• Arterial
Central venous catheters
Peripherally inserted central venous catheters
Special catheters
• Hemodialysis Catheters
• Introducer Sheaths
• Pulmonary Artery Catheters
5. Catheter Material
5
Made of synthetic polymers (polyurethane
and silicone) that are chemically inert,
biocompatible, and resistant to chemical
and thermal degradation.
Peripheral vascular catheters (arterial and
venous), central venous catheters, and
pulmonary artery catheters are mostly
made of polyurethane, peripherally-
inserted central venous catheters (PICCs)
are mostly made of silicone.
6. Catheter Size
6
• Gauge size varies
inversely with OD
(i.e., higher the
gauge size, the
smaller the OD);
• however, there is
no fixed
relationship
between gauge
size and OD.
Gauge Size
Determined by the outside diameter (OD) of the catheter.
• Superior to the gauge
system because of its
simplicity and uniformity.
• begins at zero, and each
increment of one French unit
represents an increase of
1/3 (0.33) mm in OD:
• French size × 0.33= OD
(mm).
• 3 French units in size will
have an OD of 3 × 0.33 = 1.0
mm.
French Size
8. Catheter Flow
8
Hagen-Poiseuille equation.
Steady flow (Q) in a rigid tube is directly
related to the fourth power of the inner
radius of the tube (r4), and is inversely
related to the length of the tube (L) and
the viscosity of the fluid (μ).
9. PERIPHERAL VASCULAR
CATHETERS9
Peripheral blood vessels in adults are
cannulated typically 16–20 gauge catheters
that are 1–2 inches in length.
inserted using a catheter-over-needle device.
Once flashback is evident, the catheter is
advanced over the needle and into the lumen
of the blood vessel.
10. Catheter-over-needle device for the
cannulation of peripheral blood vessels.
10
The catheter fits snugly over the needle and has a
tapered end to prevent fraying of the catheter tip during
insertion.
The needle has a clear hub to visualize the “flashback”
of blood that occurs when the tip of the needle enters
the lumen of a blood vessel.
11.
12. 12
Safety needle guard automatically covers the
needle's sharp bevel after withdrawal of needle
from the hub, minimizing the risk of needle stick
injuries.
15. Indications:
15
Fluid and electrolyte replacement
Administration of medicines
Administration of blood/blood
products
Administration of Total Parenteral
Nutrition
Haemodynamic monitoring
Blood sampling
16. Advantages:
16
Immediate effect
Control over the rate of administration
Patient cannot tolerate drugs / fluids
orally
Some drugs cannot be absorbed by
any other route
Pain and irritation is avoided
compared to some substances when
given SC/IM
17. What equipment do you
need?17
Dressing Tray
Non Sterile Gloves/Apron
Cleaning Wipes
Gauze swab
IV cannula (separate slide)
Tourniquet
Dressing to secure cannula
Alcohol wipes
Saline flush and sterile syringe or fluid to be
administered
Sharps bin
18. Preperation:
18
Consult with patient
Give explanation
Gain consent
Position the patient appropriately and identify
the non-dominant hand/arm
Support arm on pillow or in other suitable
manner.
Check for any contra-indications e.g. infection,
damaged tissue, AV fistula etc.
19. Encourage venous filling by:
19
Correctly applying a
tourniquet (applied to
the patient’s
upper/lower arm at a
pressure which is high
enough to impede
venous distension but
not to restrict arterial
flow)
Opening & closing the
fist
20. What are the signs of a good
vein?20
Bouncy
Soft
Above previous
sites
Refills when
depressed
Visible
Has a large lumen
Well supported
Straight
Easily palpable
22. What veins should you avoid?
22
Thrombosed / sclerosed / fibrosed
Inflamed / bruised
Thin / Fragile
Mobile
Near bony prominences
Areas or sites of infection, oedema or
phlebitis
Have undergone multiple previous
punctures
Do not use if patient has IV fluid in situ
23. Small vs. Large Veins
23
Catheters placed in small, peripheral veins have a
limited life expectancy because they promote
localized inflammation and thrombosis.
The inflammation is prompted by mechanical
injury to the blood vessel and by chemical injury to
the vessel from caustic drug infusions.
The thrombosis is incited by the inflammation, and
is propagated by the sluggish flow in small,
cannulated veins (low flow in small, cannulated
veins is associated with an increase in blood
viscosity, and this increases the propensity for
thrombus formation).
24. 24
Large veins offer the advantages of a larger
diameter and higher flow rates.
The larger diameter allows the insertion of
larger bore, multilumen catheters, which
increases the efficiency of vascular access
(i.e., more infusions per venipuncture).
The higher flow rates reduce the damaging
effects of infused fluids and thereby reduce the
propensity for local thrombosis.
25. Procedure
25
Wash hands
Prepare equipments
Remove the cannula from the packaging
and check all parts are operational
Loosen the white cap and gently replace
it
Apply tourniquet
Identify vein
Clean the site over the vein with alcohol
wipe, allow to dry
26. 26
Remove tourniquet if not able to proceed
Put on non-sterile gloves
Re-apply the tourniquet, 7-10 cm above site
Remove the protective sleeve from the needle
taking care not to touch it at any time
Hold the cannula in your dominant hand,
stretch the skin over the vein to anchor the
vein with your non-dominant hand (Do not re
palpate the vein)
27. 27
Insert the needle (bevel side up) at an angle of
10-30o to the skin (this will depend on vein
depth.)
Observe for blood in the flashback chamber
Lower the cannula slightly to ensure it enters the
lumen and does not puncture exterior wall of the
vessel
Gently advance the cannula over the needle
whilst withdrawing the guide, noting secondary
flashback along the cannula
28. 28
Release the tourniquet
Apply gentle pressure over the vein (beyond
the cannula tip) remove the white cap from the
needle
Remove the needle from the cannula and
dispose of it into a sharps container
Attach the white lock cap
Secure the cannula with an appropriate
dressing
Flush the cannula with 2-5 mls 0.9% Sodium
Chloride or attach an IV giving set and fluid
29. Finally:
29
Document the procedure including
Date & time
Site and size of cannula
Any problems encountered
Review date (cannula should be in situ no
longer than 72 hours without appropriate risk
assessment.)
Note: some hospitals have pre-printed forms
to record cannula events
Thank the patient
Clean up, dispose of rubbish
30. Possible Complications:
30
direct access to a patient's vascular system so
provides a potential route for entry of micro
organisms into that system.
cause serious infection if they are allowed to
enter and proliferate in the IV cannula,
insertion site, or IV fluid.
31. IV-Site Infection:
31
Does not produce much (if any) pus or
inflammation at the IV site. This is the most
common cannula-related infection.
32. Cellulites:
32
Warm, red and often tender skin surrounding
the site of cannula insertion; pus is rarely
detectable.
33. Infiltration or tissuing
33
occurs when the infusion (fluid) leaks into the
surrounding tissue. It is important to detect
early as tissue necrosis could occur – re-site
cannula immediately
34. Thrombolism / thrombophlebitis
34
occur when a small clot becomes detached
from the sheath of the cannula or the vessel
wall – prevention is the greatest form of
defence.
Flush cannula regularly and consider re-siting
the cannula if in prolonged use.
35. Extravasation
35
accidental administration of IV drugs into the
surrounding tissue, because the needle has
punctured the vein and the infusion goes directly
into the arm tissue.
The leakage of high osmolarity solutions or
chemotherapy agents can result in significant tissue
destruction, and significant complications
36. Bruising
36
commonly results from failed IV placement -
particularly in the elderly and those on
anticoagulant therapy.
37. Air embolism
37
occurs when air enters the infusion line,
although this is very rare it is best if we
consider the preventive measures – Make sure
all lines are well primed prior to use and
connections are secure
38. Haematoma
38
occurs when blood leaks out of the infusion site.
The common cause of this is using cannula that
are not tapered at the distal end. It will also
occur if on insertion the cannula has penetrated
through the other side of the vessel wall – apply
pressure to the site for approximately 4 minutes
and elevate the limb
39. Phlebitis
39
It is common in IV therapy and can be caused
in many ways.
It is inflammation of a vein (redness and pain
at the infusion site)
prevention can be using aseptic insertion
techniques, choosing the smallest gauge
cannula possible for the prescribed treatment,
secure the cannula properly to prevent
movement and carry out regular checks of the
infusion site.
40. Arterial catheter
40
a thin catheter inserted into an artery.
to monitor the BP real-time (rather than by
intermittent measurement), and to obtain
samples for ABG measurements.
not used to administer medication
inserted in the wrist (radial artery); but can also
be inserted into the elbow (brachial artery),
groin (femoral artery), foot (dorsalis pedis
artery) or the inside of the wrist (ulnar artery).
41. Central Venous Catheters
41
Used for cannulation of larger, more centrally placed
veins (i.e., subclavian, internal jugular, and femoral
veins) is often necessary for reliable vascular
access in critically ill patients.
They are typically 15 to 30 cm (6 to 12 inches) in
length, and have single or multiple (2–4) infusion
channels.
Multilumen catheters are favored in the critically ill
patient recquires a multitude of parenteral therapies
(e.g., fluids, drugs, and nutrient mixtures).
Multilumen catheters make it possible to deliver
these therapies using a single venipuncture.
42. 42
Triple-lumen catheters are favorite for central
venous access.
These catheters are available in sizes of 4-9
French.
Size 7 French(OD=23mm) triple lumen
catheter is a popular choice in adults, which
typically have one 16 gauge channel and two
smaller 18 gauge channels.
To prevent mixing of infusate solutions, the
three outflow ports are separated.
45. Indications
45
When peripheral venous access is difficult to
obtain (e.g., in obese or intravenous drug
abusers) or difficult to maintain (e.g., in agitated
patients).
For the delivery of vasoconstrictor drugs (e.g.,
dopamine, norepinephrine), hypertonic solutions
(e.g., parenteral nutrition formulas), or multiple
parenteral medications.
For prolonged parenteral drug therapy (i.e., more
than a few days).
For specialized tasks such as hemodialysis,
transvenous cardiac pacing, or hemodynamic
monitoring (e.g., with pulmonary artery catheters).
46. Contraindications:
46
There are no absolute contraindications
except inexperienced operator is in this
procedure, including the presence or severity
of a coagulation disorder.
Relative contraindicatios
Inexperience operator with unsupervised
operator, Local infection, Distorted local
anatomy, Coagulopathy, Previous radiation
therapy, Suspected proximal vascular injury
47. Insertion Technique
47
Central venous catheters are inserted by
threading the catheter over a guidewire
(Seldinger technique).
A small bore needle (usually 20 gauge) is used
to probe for the target vessel. When the tip of
the needle enters the vessel, a long, thin wire
with a flexible tip is passed through the needle
and into the vessel lumen.
The needle is then removed, and a catheter is
advanced over the guidewire and into the
blood vessel.
48. Seldinger technique
48
When cannulating deep vessels, a larger and
more rigid “dilator catheter” is first threaded
over the
guide-wire to create a tract that facilitates
insertion of the vascular catheter.
50. Peripherally Inserted Central
Catheters50
peripherally inserted central catheters (PICCs),
which are inserted in the basilic or cephalic vein in
the arm (just above the antecubital fossa) and
advanced into the superior vena cava.
Useful in patients with concern for the adverse
consequences of central venous cannulation (e.g.,
pneumothorax arterial puncture, poor patient
acceptance)
PICCs are used primarily when traditional central
venous accesss are considered risky (e.g., severe
thrombocytopenia) or are difficult to obtain (e.g.,
morbid obesity).
52. PICC vs CVC
52
Major distinction between PICCs and central
venous catheters is their length; i.e., the length of
the catheters(50 cm and 70 cm) is at least double
the length of the triple lumen catheters.
Because of this added length there is reduction in
flow capacity in PICC.
Flow is particularly sluggish in the double lumen
PICCs because of the smaller diameter of the
infusion channels.
The flow limitation of PICCs (especially the double
lumen catheters) makes them ill-suited for
aggressive volume therapy.
53. Hemodialysis Catheters
53
One of the recognized benefits of intensive care
units is the ability to provide emergent
hemodialysis for patients with acute renal failure,
Hemodialysis catheters are the wide-body
catheters of critical care, with diameters up to 16
French (5.3 mm), and they are equipped with dual
12 gauge infusion channels that can
accommodate the high flow rates (200–300
mL/min) needed for effective hemodialysis.
One channel carries blood from the patient to the
dialysis membranes, and the other channel
returns the blood to the patient.
56. Introducer Sheaths
56
Introducer sheaths are large-bore (8–9
French) catheters that serve as conduits for
the insertion and removal of temporary
vascular devices.
They are used primarily to facilitate the
placement of pulmonary artery (PA) catheters
The introducer sheath is first placed in a large,
central vein, and the PA catheter is then
threaded through the sheath and advanced
into the pulmonary artery.
57. 57
The placement of PA catheters often requires
repeated trials of advancing and retracting the
catheter to achieve the proper position in the
pulmonary artery, and the introducer sheath
facilitates these movements.
When the PA catheter is no longer needed, the
introducer sheath allows the catheter to be
removed and replaced with a central venous
catheter, if needed, without a new venipuncture.
serve as stand-alone infusion devices-with
pressurized infusion systems, flow rates of 850
mL/min have been reported
58. Pulmonary Artery Catheters
58
Pulmonary artery balloon-flotation catheters
are highly specialized devices capable of
providing various measures of cardiovascular
function and systemic oxygenation.
The use of multiple infusion channels does not increase the incidence of catheter-related infections, but the larger diameter of multilumen catheters creates an increased risk of catheter-induced thrombosis.