This document provides information on peripheral IV insertion in pediatric patients. It discusses indications, contraindications, equipment, risks, local anesthesia techniques, tips for insertion, preferred insertion sites, difficult access considerations, intraosseous line insertion, PICCs, and care of IV lines. The goal is to safely and effectively place IV lines in children while minimizing pain and risks of complications. Proper patient positioning, site selection, anesthesia, and post-insertion care are emphasized.
An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used in airway management.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
Pediatric IV cannulation is insertion of cannula into the vein for the purpose of administering medications / Infusion therapy / Transfusion of blood and its products /Nutrition to childrens
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.
An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used in airway management.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
Pediatric IV cannulation is insertion of cannula into the vein for the purpose of administering medications / Infusion therapy / Transfusion of blood and its products /Nutrition to childrens
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 Cannulation Introducing a single dose of concentrated medication directly...ssuser3155141
Introducing a single dose of concentrated medication directly into the systemic circulation
“Or”
The introduction of a large amount of fluid & electrolytes and other nutrients into the body via veins.
Safe iv cannulation (prevention of iv thrombophlebitis)Chaithanya Malalur
A basic introduction to applying an intravenous canula. A note on commonly accessible veins, purpose of IV cannulation, materials & procedure, after care, complications & management
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!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. Indications
1. Administration of fluids and electrolytes.
2. Administration of intravenous medications.
3. Administration of blood and blood products.
4. Blood sampling.
3. Contraindications
Absolute
1. Do not insert through an infected site.
2. Do not insert through a burn.
3. Do not insert in an injured site.
Relative
1. Avoid a paralyzed extremity.
2. Do not insert in a massively edematous extremity.
3. Do not insert an IV distal to injured organs (eg, do not use lower extremities
when treating abdominal injuries).
4. Avoid joint area.
4. Equipment
Caution: All equipment must be latex free.
1. Gloves.
2. Tourniquet or rubber band.
3. Tape and occlusive transparent dressing.
4. Alcohol wipes.
5. Povidone or chlorhexidine.
6. Syringe filled with injectable saline.
7. Gauze pads.
8. IV device: catheter or butterfly of appropriate size to fit the patient and the task.
9. Topical anesthetic cream.
10. Ultrasound guiding equipment (if available and if trained in its use).
5. Risks
1. Infection.
2. Hematoma.
3. Extravasation.
4. Compartment syndrome.
5. Severe vasoconstriction if vasoactive medications are infused through a
peripheral IV and extravasate.
6. Venous thrombosis.
7. Embolization of air or catheter fragment.
6. Local anesthesia
4% Lidocaine cream is administered
topically after disinfection of insertion
site
2.5 grams applied to the skin and
covered with an occlusive dressing
(Tegaderm) overlying the IV site, 30
minutes before the procedure
It effectively reduces pain and anxiety
associated with venipuncture in
children
7. Pearls and Tips
2 trial per person, maximum 6 trials per 3 persons
Examine all possible sites carefully before choosing one.
Let gravity work on your side
Apply gentle circumferential pressure with 1 hand on the extremity to fill up the
veins, which helps identify the most appropriate site.
Apply heat to promote vasodilation
In choosing the equipment and the site for the line, consider the patient’s needs
Keep in mind other procedures
After disinfecting the venipuncture site, let the alcohol dry for a while. IV
insertion becomes much more painful when you do it using a needle coated with
alcohol.
23. Identify the blood vessel by palpation, visualization, transillumination, or
ultrasound.
Flush the catheter and the connecting tube with saline (omit this step if you
intend to draw blood through this catheter).
Apply tourniquet.
Use your nondominant hand to apply traction on the skin linearly or
circumferentially in order to stabilize the vein.
Enter the skin at a 20- to 30-degree angle proximal to or alongside the vein
Reduce the angle as you advance the catheter and enter the vein.
Watch for blood flashback in the hub of the catheter.
Stabilize the catheter with the thumb and middle finger of your dominant hand
and advance the catheter over the stylet using the tip of your index finger
24. Remove the stylet.
Do not reinsert the stylet once it has been removed; it may damage the
catheter.
Release the tourniquet.
Connect the extension tubing and saline-filled syringe to the catheter.
Gently flush the catheter; observe for swelling, mottling, or color changes in
the extremity.
Secure the IV with occlusive transparent dressing and tape.
Make a small loop in the IV tubing and tape it across. Attach the line to an IV
infusion assembly and turn the pump on.
Dispose of all sharp instruments in the proper secure container.
25. Fixation of the IV line
Make a small loop in the IV tubing and tape it across
26.
27.
28.
29. Patient Positioning
Position the patient with the chosen site closest to you.
Have a helper gently restrain and distract the child.
Have the patient at a comfortable working height.
For external jugular line placement, have the patient’s head lower than the
trunk (Trendelenburg).
Have a good injection site lighting
Presence of parents?
30.
31. The preferred sites for IV cannulation
1. Hand
Dorsal arch veins
Dorsal arch veins are best seen on the back of the hand, but are
usually larger and easier to see and palpate over the back of the wrist.
Skin entry should be more distally. IVs inserted here are easily splinted
and any infiltration easily spotted, so these veins are the preferred
site.
Cephalic vein, in anatomical snuffbox
The cephalic vein is often quite large and can often be felt better than
it can be seen. It is one of the veins to try if you must cannulate ‘blind’
in a large baby.
Cannulas in this position tend to last quite well, making this a good
secondary site.
32. 2. Wrist
Volar aspect
Veins are easily seen on the volar side
of the wrist. They are usually quite
small and fragile and whilst easily
cannulated, do not last well.
They are useful secondary sites, but
must be carefully watched when
noxious substances (eg Dopamine,
Vancomycin) are infused, as they are
prone to ‘burn’.
33. 3. Cubital fossa
Median antecubital, cephalic and basilic
veins
Median antecubital, cephalic and basilic
veins are easy to hit and tend to last
quite well if splinted properly. These
veins are the preferred sites for
insertion of percutaneous central
venous catheters. These should be
avoided unless absolutely necessary in
any infant likely to need long term IV
therapy.
The median nerve and brachial artery
are both in the same anatomical
vicinity and therefore vulnerable to
damage.
34. 4. Foot
Dorsal arch
Dorsal arch veins are small, but
easily cannulated and last
surprisingly well.
The vein on the lateral aspect,
running below malleolus, is easy to
access, but must be splinted
carefully and watched for
infiltration.
Veins leading up to short
saphenous are often good options.
35. 4. Foot
Saphenous vein, ankle
The saphenous vein runs reliably just
anterior to medial malleolus and is
large and straight. It is easy to access
and lasts well although is not always
readily visualized.
These veins are also good sites for
insertion of percutaneous central
venous catheters and should again
be avoided in an infant likely to need
long term IV access.
36. 5.Leg
Saphenous vein at the knee
The saphenous vein runs just behind the medial aspect
of the knee and is often visible behind the knee and as it
curves around the top of the tibia. Access is easy and
lasts well if properly splinted. However, this vein is a
good site for the insertion of percutaneous central
venous catheters and should be avoided if possible, in
any infant likely to need long term IV access.
37. 6. Scalp
Scalp veins should only be used once
other alternatives are exhausted.
Mostly at least partial shaving of the
head is required.
It may take 6 months for hair to grow
back properly, which may cause
significant parental distress.
38. Superficial temporal vein
The superficial temporal vein runs anterior to the
ear and is accessible over a distance of 5-8 cm in
most babies and lasts well if secured
appropriately
This vein is also a good site for the insertion of
percutaneous central venous catheters and
should be avoided if possible in infants likely to
need long term IV access.
The proximity of the temporal artery, which runs
beside it, is a hazard.
In small infants it can be almost impossible to tell
the difference, even when the catheter has been
inserted. It is important to try to identify the
vessels separately, by careful palpation
41. Assess difficulty of intravenous cannulation
History of 'difficult' IV access in the medical record
Patient or caregiver reports a history of difficulty in cannulating or venipuncture
Clinical assessment. The DIVA (Difficult Intravenous Access) score may be helpful
Score of 4 or more means >50% chance of failed initial attempt
The Sydney Children’s Hospital Network. Intravenous cannulation and venupuncture
45. Contraindications
Absolute
Trauma to the bone at or proximal to the insertion site (allows extravasation of fluids and therefore a
risk of compartment syndrome).
Bone diseases including:
1. osteogenesis imperfecta
2. osteoporosis
3. osteomyelitis.
Infection of the tissues overlying the insertion site.
Relative
Previous orthopedic surgery near to the insertion site (prostheses, tibial nails) could lead to
unpredictable flow due to disruption of bone matrix.
Previous IO cannulation at the same site within the preceding 24-48 hours.
Inability to locate landmarks.
Clotting disorders.
46. Common insertion technique for all devices
1. Explain the procedure to patient and relatives.
2. Obtain skilled assistance as needed.
3. Universal precautions.
4. Identify site and position appropriately, manually stabilizing the bone
(ensuring the hand is not placed under the limb).
5. Clean site and administer local anesthetic in the conscious child.
47. Common insertion technique for all devices
6. Once the needle is stable (unsupported) within the cortex, remove the stylet
and aspirate blood marrow.
7. Syringe bolus: flush the catheter with 10 ml of normal saline (using lidocaine in
the conscious patient for analgesia).
8. Apply stabilizer dressing.
9. Ensure the needle is flushed with at least 10 ml of fluid after drug
administration.
10. Clear documentation of the procedure in the patient notes.
11. Frequent assessment of the IO site for signs of extravasation.
48. Diagnostic tests
Cross match
Carbon dioxide and platelet measurements (may be lower in intraosseous
samples)
Leukocyte count may be higher
Sodium, potassium and calcium values obtained from blood and marrow
mixtures may also be inaccurate
Coagulation studies are inaccurate
49. Pain
The pain associated with insertion of IO devices in the conscious patient is
variable
Infusion of drugs and fluids into the bone marrow cavity under pressure
triggers multiple intraosseous pain receptors and the pain is severe.
The infusion of 0.5 mg/kg of 2% lidocaine (without adrenaline and
preservative free) prior to the infusion of drugs and fluids is effective in
controlling this pain.
Repeat boluses may need to be administered taking care to calculate the
maximum safe dose of lidocaine (3 mg/kg).
50. Complications
Complications resulting from IO cannulation are rare (thought to be less than 1%).
Dislodgment of the cannula.
Fracture of the target bone. Follow up radiograph should be obtained for all
children in whom IO cannulation has been attempted.
Infection of the bone (0.6%)3 or surrounding tissues:
Extravasation of fluid or medications resulting in tissue damage or compartment
syndrome.
Pain on use.
Skin necrosis.
Growth plate injury.
60. Care for the IV line
TOUCH for signs of temperature change (heat or warmth) or leakage at the IV
site
LOOK to make sure the IV site is dry and visible at all times.
COMPARE the IV site (such as the hand or leg) with the opposite limb to look for
signs of swelling
61. If an IV line is not working properly, your child may experience any of the following
symptoms:
1. Hand with redness and leakage at IV site
2. General pain or pain to the touch at the IV site
3. Swelling of the area where the IV line is inserted
4. Numbness at the area
5. Redness
6. Bruising
7. Wetness at the area, suggesting that the IV line is leaking
8. Firmness at the area, which may be related to swelling
9. Warmth or coolness at the IV site
Complications