A central line is an intravenous device inserted into major veins in the neck, chest or groin to administer medications, fluids, and blood tests or monitor cardiovascular measurements. There are several types including short-term, PICC lines, tunneled catheters, and implanted ports. Central lines can be open-ended, requiring clamping, or closed-ended with a valve. They are used to provide long-term IV access, administer medications or fluids, and monitor central venous pressure. Proper insertion using the Seldinger technique and maximal sterile barriers are important to prevent complications like infection, thrombosis, and pneumothorax.
The document discusses guidelines for central venous catheter care including proper insertion, maintenance, and removal techniques to ensure safe and effective intravenous therapy and reduce infections, with specific details provided for peripherally inserted central catheters and infusaports. Proper identification and care procedures are outlined for power ports that can be used for contrast dye injections.
A new strategy of using peripherally inserted central catheters (PICCs) as the first choice for central venous access is becoming widespread. The document discusses how ultrasound guidance and the use of microintroducer techniques have improved the safety and effectiveness of PICC insertion by nurses. Tip placement is now routinely confirmed with intracavitary electrocardiography during the procedure rather than relying on chest x-rays after, improving accuracy and allowing treatment to begin immediately. This real-time verification with a low-cost method is beneficial to patients and the healthcare system.
This document provides information and best practices for central and peripherally inserted central catheters (PICCs). It discusses indications for central lines, types of central lines including non-tunneled and PICCs, catheter placement and tips, dressing changes, flushing procedures, and documentation standards. The document emphasizes following Centers for Disease Control and Prevention guidelines to prevent infections, including using sterile technique and chlorhexidine for dressing changes and site access. It also stresses the importance of daily site assessments and prompt removal of unnecessary lines.
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 document discusses various devices used in the intensive care unit (ICU). It describes patient monitoring equipment like bedside monitors, pulse oximeters, and intracranial pressure monitors that continuously track vital signs. Life support devices discussed include mechanical ventilators, infusion pumps, and defibrillators used for emergency resuscitation. The roles of nurses in monitoring devices and addressing alarms is emphasized. Complications of equipment like arterial lines and ventilators are also reviewed.
This document provides information on peripherally inserted central catheters (PICCs), including guidelines for insertion and care. PICCs are long, thin tubes inserted into a vein in the arm and advanced into the heart to provide intravenous access. They can remain in place for extended periods. Proper care includes hand hygiene, aseptic technique, dressing changes according to guidelines, and flushing/locking to maintain patency and prevent infection. Potential complications include infection, obstruction, phlebitis, malposition, air embolism, and venous spasm. PICCs should not be removed due to risks of air embolism, syncope, venous spasm, and catheter fracture.
Critical care units such as intensive care units (ICUs) and critical care units (CCUs) provide specialized intensive care for critically ill patients. There are many different types of ICUs depending on medical specialty, such as neonatal ICUs, cardiac ICUs, and surgical ICUs. ICUs are equipped with mechanical ventilators and extensive monitoring equipment to support vital organ functions. Mechanical ventilation is often required to assist patients who cannot breathe adequately on their own. There are various modes of mechanical ventilation to meet patients' different respiratory needs.
A central line is an intravenous device inserted into major veins in the neck, chest or groin to administer medications, fluids, and blood tests or monitor cardiovascular measurements. There are several types including short-term, PICC lines, tunneled catheters, and implanted ports. Central lines can be open-ended, requiring clamping, or closed-ended with a valve. They are used to provide long-term IV access, administer medications or fluids, and monitor central venous pressure. Proper insertion using the Seldinger technique and maximal sterile barriers are important to prevent complications like infection, thrombosis, and pneumothorax.
The document discusses guidelines for central venous catheter care including proper insertion, maintenance, and removal techniques to ensure safe and effective intravenous therapy and reduce infections, with specific details provided for peripherally inserted central catheters and infusaports. Proper identification and care procedures are outlined for power ports that can be used for contrast dye injections.
A new strategy of using peripherally inserted central catheters (PICCs) as the first choice for central venous access is becoming widespread. The document discusses how ultrasound guidance and the use of microintroducer techniques have improved the safety and effectiveness of PICC insertion by nurses. Tip placement is now routinely confirmed with intracavitary electrocardiography during the procedure rather than relying on chest x-rays after, improving accuracy and allowing treatment to begin immediately. This real-time verification with a low-cost method is beneficial to patients and the healthcare system.
This document provides information and best practices for central and peripherally inserted central catheters (PICCs). It discusses indications for central lines, types of central lines including non-tunneled and PICCs, catheter placement and tips, dressing changes, flushing procedures, and documentation standards. The document emphasizes following Centers for Disease Control and Prevention guidelines to prevent infections, including using sterile technique and chlorhexidine for dressing changes and site access. It also stresses the importance of daily site assessments and prompt removal of unnecessary lines.
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 document discusses various devices used in the intensive care unit (ICU). It describes patient monitoring equipment like bedside monitors, pulse oximeters, and intracranial pressure monitors that continuously track vital signs. Life support devices discussed include mechanical ventilators, infusion pumps, and defibrillators used for emergency resuscitation. The roles of nurses in monitoring devices and addressing alarms is emphasized. Complications of equipment like arterial lines and ventilators are also reviewed.
This document provides information on peripherally inserted central catheters (PICCs), including guidelines for insertion and care. PICCs are long, thin tubes inserted into a vein in the arm and advanced into the heart to provide intravenous access. They can remain in place for extended periods. Proper care includes hand hygiene, aseptic technique, dressing changes according to guidelines, and flushing/locking to maintain patency and prevent infection. Potential complications include infection, obstruction, phlebitis, malposition, air embolism, and venous spasm. PICCs should not be removed due to risks of air embolism, syncope, venous spasm, and catheter fracture.
Critical care units such as intensive care units (ICUs) and critical care units (CCUs) provide specialized intensive care for critically ill patients. There are many different types of ICUs depending on medical specialty, such as neonatal ICUs, cardiac ICUs, and surgical ICUs. ICUs are equipped with mechanical ventilators and extensive monitoring equipment to support vital organ functions. Mechanical ventilation is often required to assist patients who cannot breathe adequately on their own. There are various modes of mechanical ventilation to meet patients' different respiratory needs.
The document discusses various devices used in intensive care units (ICUs). It describes patient monitoring equipment like arterial lines, bedside monitors, ventilators, and intracranial pressure monitors that are used to continuously track vital signs. It also discusses life support devices like mechanical ventilators and resuscitation carts. The roles of these devices and nursing care responsibilities are explained over multiple pages.
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
The document provides information on catheter-related bloodstream infections (CR-BSIs) including what they are, where they come from, why proper central venous catheter (CVC) care and maintenance is crucial to prevent them, and recommendations from the CDC on prevention. CR-BSIs are associated with high morbidity, mortality, and costs. Adherence to best practices like aseptic technique during insertion and dressing changes, appropriate hand hygiene, and following policies on injection caps, flushing and medication administration can help reduce the risk of these infections.
2. central venous access devices (cvads)ChartwellPA
Central venous catheters can be categorized into four groups based on their design: peripherally inserted central catheters, temporary central venous catheters, permanent tunneled central venous catheters, and implantable ports. It is the nurse's responsibility to understand the design, purpose, and care of each type of catheter and educate patients. PICC lines are long, flexible tubes inserted into a peripheral vein and threaded into the central circulation. They are commonly used for short or long-term therapies and have a lower risk of complications than other central lines. Implantable ports are implanted subcutaneously and consist of a portal body and catheter, providing vascular access without an external component.
CVAD Management, Care and Maintenance (Radiology Nursing)Sarah Cox
Central venous access devices (CVADs) require careful management to prevent complications. There are two main types of CVADs - external and internal. External devices are short-term while internal devices like ports can remain for years. Proper infection control including hand hygiene is essential to prevent catheter-related bloodstream infections. Nurses must regularly assess the CVAD site and dressing and know how to properly access, flush, and secure the device. Occlusions and tip migration are potential complications that require monitoring and troubleshooting.
Intensive care units are equipped with various monitoring and life support devices to care for critically ill patients. These include patient monitoring equipment like ECG machines and pulse oximeters, life support devices like ventilators and infusion pumps, and diagnostic tools like portable x-rays. Central lines and arterial lines provide vascular access. Other important devices are bedside monitors to continuously track vital signs, intracranial pressure monitors for brain injuries, and crash carts containing emergency resuscitation equipment. Nurses are responsible for properly operating and maintaining these devices to closely monitor patients and support life.
Needleless connectors are devices used to connect IV lines, administration sets, and syringes while preventing needlestick injuries. There are two main types - simple connectors that allow straight fluid flow, and complex connectors with internal valves controlling flow. Proper cleaning and use of connectors is important to prevent bloodstream infections. The document discusses different connector designs, cleaning protocols, risks of infection from different designs, and importance of training on proper use.
The document discusses various devices used in intensive care units (ICUs) for patient monitoring and life support. It describes equipment for monitoring vital signs like heart rate and blood pressure. Devices discussed include arterial lines, central venous lines, pulse oximeters, ventilators, infusion pumps, and crash carts. The roles of nurses in operating and overseeing this equipment are also reviewed.
This document provides information on central venous catheterization, including indications, contraindications, complications, techniques, and tips. It discusses the Seldinger technique for placement and locations for catheter insertion, including the internal jugular, subclavian, and femoral veins. Precautions are outlined for each approach. Ultrasound guidance is becoming standard to visualize the vein and compress it during insertion.
Central venous catheters are inserted into central veins to deliver fluids, medications, or monitor central venous pressure. The three main sites for central venous catheter placement are the internal jugular, subclavian, and femoral veins. Potential complications include hemorrhage, pneumothorax, and guidewire entanglement. Care must be taken to inspect guidewires and hold them securely during insertion and removal to avoid complications.
Central Venous Access and Catheters. Their indications and contraindications, Different types of central catheters and their advantages and disadvantages, Technique of insertion, and Complications related to central venous lines.
The document discusses common equipment used in intensive care units (ICU) to monitor patients and treat illnesses. Patients in the ICU are often connected to bedside monitors that track vital signs like heart rate, blood pressure, oxygen levels. Intravenous (IV) catheters are used to deliver fluids and medications into blood vessels. Ventilators are used to support breathing by inserting breathing tubes through the mouth or tracheostomy in the neck. Other equipment discussed includes arterial lines to monitor blood pressure, pacemakers to regulate abnormal heart rhythms, chest tubes to drain fluids from the lungs, and feeding tubes for providing nutrition.
This document provides an overview of the types of equipment used in intensive care units (ICUs). It discusses various patient monitoring devices like pulse oximeters, bedside monitors, and electrocardiography machines that are used to monitor vital signs. Life support devices like mechanical ventilators, infusion pumps, and defibrillators that provide respiratory and circulatory support are also covered. The document describes different hemodynamic monitoring tools including arterial lines, pulmonary artery catheters, and intracranial pressure monitors.
RESUSCIATION EQUIPMENTS IN INTENSISIVE CARE UNITSANILKUMAR BR
Intensive care unit (ICU) equipment includes patient monitoring, respiratory and cardiac support, pain management, emergency resuscitation devices, and other life support equipment .
They are designed to care for patients who are seriously injured, have a critical or life-threatening illness, or have undergone a major surgical procedure thereby requiring 24-hour care and monitoring.
Intensive care unit equipment includes
Patient monitoring devices
Life support and emergency resuscitation devices, and
Diagnostic devices.
This document provides guidelines for obtaining blood specimens from umbilical catheters in a neonatal intensive care unit. It outlines sterile technique and procedures to prevent blood loss and air bubbles when collecting samples from umbilical arterial catheters (UAC) and umbilical venous catheters (UVC). Steps include aspirating saline to clear the line, using a neutral stopcock position, carefully aspirating and injecting small amounts of blood, and flushing the line after to remove any residual blood and prevent clots. Nurses must monitor infants for signs of arterial spasm or embolism following the procedure.
This document provides information on the demonstration of peripheral and central line insertion. It begins by defining a peripheral venous line as a catheter placed in a peripheral vein for intravenous therapy. It then discusses the steps for peripheral line insertion and possible complications. The document next defines central line catheterization as a catheter placed in the thoracic veins or heart. It discusses the indications, sites of insertion, requirements, procedure using the Seldinger technique, and complications of central line insertion. Finally, it covers peripherally inserted central catheters as an alternative to other central lines.
This document provides information about a central venous catheter (CVC) insertion workshop focusing on the right internal jugular vein. It discusses indications and contraindications for CVC placement, possible complications, common sites for insertion, and summarizes a study comparing infection rates between sites. It also reviews surface anatomy of insertion sites, ultrasound basics including machine settings and imaging planes. The document outlines the Seldinger technique for CVC insertion and provides an equipment list with images of required supplies.
This document provides an overview of central venous catheterization. It discusses the types of central venous catheters including non-tunneled, tunneled, peripherally inserted central catheters, and implantable ports. It also covers indications, contraindications, techniques, complications, and tips for placement of central lines in the internal jugular, subclavian, and femoral veins. Ultrasound-guided central venous access is also discussed as the standard of care.
The document describes various equipment used in an intensive care unit (ICU). It includes ventilators to help patients breathe, monitors to track vital signs, infusion pumps for delivering medications, and other devices like defibrillators, ultrasound machines, and beds that can be adjusted electronically. Key life-saving equipment includes ventilators, monitors for vital signs, devices to support blood pressure and circulation like intra-aortic balloon pumps, and extracorporeal membrane oxygenation (ECMO) systems that can function like an external heart and lungs.
A review of Best Practices in Vascular Access and Infusion Therapy presentati...bsulejma09
This document discusses vascular access and intravenous therapy. It begins with the presenter introducing themselves and their background and disclosures. The objectives of the presentation are then outlined, which include gaining knowledge about vein anatomy, infusion principles, vascular access devices, vessel health, building a successful infusion program, new research, and technology. Details are then provided about various topics related to vascular access including vein anatomy, principles of infusion, hemodilution, choosing the right device, complications, and decreasing complications through developing an infusion program. Financial considerations of sending patients out for line placement versus keeping them in the facility are reviewed. The roles and responsibilities of bedside nurses are discussed in relation to standards of practice from organizations like the Infusion Nurses Society
The presentation discusses the respiratory system and central venous pressure (CVP). CVP reflects the amount of blood returning to the heart and the heart's ability to pump blood into the arteries. Factors that increase CVP include hypervolemia and decreased cardiac output, while factors that decrease CVP include hypovolemia and distributive shock. Complications from CVP lines include infections, air embolisms, and catheter dislodgement. Nurses must monitor patients for complications and ensure secure connections to prevent issues like exsanguination or introduction of infection.
The document discusses central venous pressure (CVP) monitoring. It aims to explain what CVP is, the purposes and indications for monitoring it, the equipment needed, nursing roles and responsibilities, potential complications, and how to interpret CVP readings. Specifically, CVP refers to the blood pressure in the right atrium and is monitored using a catheter placed in the jugular or subclavian vein. CVP provides information about a patient's fluid balance, circulating blood volume, and right heart function. Nurses must understand how to set up monitoring equipment properly and know that abnormal CVP readings should be considered in the full clinical context of the patient.
The document discusses various devices used in intensive care units (ICUs). It describes patient monitoring equipment like arterial lines, bedside monitors, ventilators, and intracranial pressure monitors that are used to continuously track vital signs. It also discusses life support devices like mechanical ventilators and resuscitation carts. The roles of these devices and nursing care responsibilities are explained over multiple pages.
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
The document provides information on catheter-related bloodstream infections (CR-BSIs) including what they are, where they come from, why proper central venous catheter (CVC) care and maintenance is crucial to prevent them, and recommendations from the CDC on prevention. CR-BSIs are associated with high morbidity, mortality, and costs. Adherence to best practices like aseptic technique during insertion and dressing changes, appropriate hand hygiene, and following policies on injection caps, flushing and medication administration can help reduce the risk of these infections.
2. central venous access devices (cvads)ChartwellPA
Central venous catheters can be categorized into four groups based on their design: peripherally inserted central catheters, temporary central venous catheters, permanent tunneled central venous catheters, and implantable ports. It is the nurse's responsibility to understand the design, purpose, and care of each type of catheter and educate patients. PICC lines are long, flexible tubes inserted into a peripheral vein and threaded into the central circulation. They are commonly used for short or long-term therapies and have a lower risk of complications than other central lines. Implantable ports are implanted subcutaneously and consist of a portal body and catheter, providing vascular access without an external component.
CVAD Management, Care and Maintenance (Radiology Nursing)Sarah Cox
Central venous access devices (CVADs) require careful management to prevent complications. There are two main types of CVADs - external and internal. External devices are short-term while internal devices like ports can remain for years. Proper infection control including hand hygiene is essential to prevent catheter-related bloodstream infections. Nurses must regularly assess the CVAD site and dressing and know how to properly access, flush, and secure the device. Occlusions and tip migration are potential complications that require monitoring and troubleshooting.
Intensive care units are equipped with various monitoring and life support devices to care for critically ill patients. These include patient monitoring equipment like ECG machines and pulse oximeters, life support devices like ventilators and infusion pumps, and diagnostic tools like portable x-rays. Central lines and arterial lines provide vascular access. Other important devices are bedside monitors to continuously track vital signs, intracranial pressure monitors for brain injuries, and crash carts containing emergency resuscitation equipment. Nurses are responsible for properly operating and maintaining these devices to closely monitor patients and support life.
Needleless connectors are devices used to connect IV lines, administration sets, and syringes while preventing needlestick injuries. There are two main types - simple connectors that allow straight fluid flow, and complex connectors with internal valves controlling flow. Proper cleaning and use of connectors is important to prevent bloodstream infections. The document discusses different connector designs, cleaning protocols, risks of infection from different designs, and importance of training on proper use.
The document discusses various devices used in intensive care units (ICUs) for patient monitoring and life support. It describes equipment for monitoring vital signs like heart rate and blood pressure. Devices discussed include arterial lines, central venous lines, pulse oximeters, ventilators, infusion pumps, and crash carts. The roles of nurses in operating and overseeing this equipment are also reviewed.
This document provides information on central venous catheterization, including indications, contraindications, complications, techniques, and tips. It discusses the Seldinger technique for placement and locations for catheter insertion, including the internal jugular, subclavian, and femoral veins. Precautions are outlined for each approach. Ultrasound guidance is becoming standard to visualize the vein and compress it during insertion.
Central venous catheters are inserted into central veins to deliver fluids, medications, or monitor central venous pressure. The three main sites for central venous catheter placement are the internal jugular, subclavian, and femoral veins. Potential complications include hemorrhage, pneumothorax, and guidewire entanglement. Care must be taken to inspect guidewires and hold them securely during insertion and removal to avoid complications.
Central Venous Access and Catheters. Their indications and contraindications, Different types of central catheters and their advantages and disadvantages, Technique of insertion, and Complications related to central venous lines.
The document discusses common equipment used in intensive care units (ICU) to monitor patients and treat illnesses. Patients in the ICU are often connected to bedside monitors that track vital signs like heart rate, blood pressure, oxygen levels. Intravenous (IV) catheters are used to deliver fluids and medications into blood vessels. Ventilators are used to support breathing by inserting breathing tubes through the mouth or tracheostomy in the neck. Other equipment discussed includes arterial lines to monitor blood pressure, pacemakers to regulate abnormal heart rhythms, chest tubes to drain fluids from the lungs, and feeding tubes for providing nutrition.
This document provides an overview of the types of equipment used in intensive care units (ICUs). It discusses various patient monitoring devices like pulse oximeters, bedside monitors, and electrocardiography machines that are used to monitor vital signs. Life support devices like mechanical ventilators, infusion pumps, and defibrillators that provide respiratory and circulatory support are also covered. The document describes different hemodynamic monitoring tools including arterial lines, pulmonary artery catheters, and intracranial pressure monitors.
RESUSCIATION EQUIPMENTS IN INTENSISIVE CARE UNITSANILKUMAR BR
Intensive care unit (ICU) equipment includes patient monitoring, respiratory and cardiac support, pain management, emergency resuscitation devices, and other life support equipment .
They are designed to care for patients who are seriously injured, have a critical or life-threatening illness, or have undergone a major surgical procedure thereby requiring 24-hour care and monitoring.
Intensive care unit equipment includes
Patient monitoring devices
Life support and emergency resuscitation devices, and
Diagnostic devices.
This document provides guidelines for obtaining blood specimens from umbilical catheters in a neonatal intensive care unit. It outlines sterile technique and procedures to prevent blood loss and air bubbles when collecting samples from umbilical arterial catheters (UAC) and umbilical venous catheters (UVC). Steps include aspirating saline to clear the line, using a neutral stopcock position, carefully aspirating and injecting small amounts of blood, and flushing the line after to remove any residual blood and prevent clots. Nurses must monitor infants for signs of arterial spasm or embolism following the procedure.
This document provides information on the demonstration of peripheral and central line insertion. It begins by defining a peripheral venous line as a catheter placed in a peripheral vein for intravenous therapy. It then discusses the steps for peripheral line insertion and possible complications. The document next defines central line catheterization as a catheter placed in the thoracic veins or heart. It discusses the indications, sites of insertion, requirements, procedure using the Seldinger technique, and complications of central line insertion. Finally, it covers peripherally inserted central catheters as an alternative to other central lines.
This document provides information about a central venous catheter (CVC) insertion workshop focusing on the right internal jugular vein. It discusses indications and contraindications for CVC placement, possible complications, common sites for insertion, and summarizes a study comparing infection rates between sites. It also reviews surface anatomy of insertion sites, ultrasound basics including machine settings and imaging planes. The document outlines the Seldinger technique for CVC insertion and provides an equipment list with images of required supplies.
This document provides an overview of central venous catheterization. It discusses the types of central venous catheters including non-tunneled, tunneled, peripherally inserted central catheters, and implantable ports. It also covers indications, contraindications, techniques, complications, and tips for placement of central lines in the internal jugular, subclavian, and femoral veins. Ultrasound-guided central venous access is also discussed as the standard of care.
The document describes various equipment used in an intensive care unit (ICU). It includes ventilators to help patients breathe, monitors to track vital signs, infusion pumps for delivering medications, and other devices like defibrillators, ultrasound machines, and beds that can be adjusted electronically. Key life-saving equipment includes ventilators, monitors for vital signs, devices to support blood pressure and circulation like intra-aortic balloon pumps, and extracorporeal membrane oxygenation (ECMO) systems that can function like an external heart and lungs.
A review of Best Practices in Vascular Access and Infusion Therapy presentati...bsulejma09
This document discusses vascular access and intravenous therapy. It begins with the presenter introducing themselves and their background and disclosures. The objectives of the presentation are then outlined, which include gaining knowledge about vein anatomy, infusion principles, vascular access devices, vessel health, building a successful infusion program, new research, and technology. Details are then provided about various topics related to vascular access including vein anatomy, principles of infusion, hemodilution, choosing the right device, complications, and decreasing complications through developing an infusion program. Financial considerations of sending patients out for line placement versus keeping them in the facility are reviewed. The roles and responsibilities of bedside nurses are discussed in relation to standards of practice from organizations like the Infusion Nurses Society
The presentation discusses the respiratory system and central venous pressure (CVP). CVP reflects the amount of blood returning to the heart and the heart's ability to pump blood into the arteries. Factors that increase CVP include hypervolemia and decreased cardiac output, while factors that decrease CVP include hypovolemia and distributive shock. Complications from CVP lines include infections, air embolisms, and catheter dislodgement. Nurses must monitor patients for complications and ensure secure connections to prevent issues like exsanguination or introduction of infection.
The document discusses central venous pressure (CVP) monitoring. It aims to explain what CVP is, the purposes and indications for monitoring it, the equipment needed, nursing roles and responsibilities, potential complications, and how to interpret CVP readings. Specifically, CVP refers to the blood pressure in the right atrium and is monitored using a catheter placed in the jugular or subclavian vein. CVP provides information about a patient's fluid balance, circulating blood volume, and right heart function. Nurses must understand how to set up monitoring equipment properly and know that abnormal CVP readings should be considered in the full clinical context of the patient.
CVP Pulmonary artery wedge pressure monitoring: PhysiologySaneesh P J
This document discusses CVP and PCWP monitoring. It begins by outlining the cardiac cycle and then defines CVP as the pressure in the thoracic vena cava near the right atrium. Factors that can increase or decrease CVP are described. CVP monitoring involves inserting a catheter into a vein to measure pressure in the right atrium. The document then discusses PCWP monitoring, which involves advancing a catheter into the pulmonary artery to measure pressure. Normal ranges for various hemodynamic parameters are provided. Contraindications for PA catheter use are also outlined.
The document describes various hemodynamic measurements and pressure tracings obtained from right heart catheterization. It discusses normal and abnormal left ventricular pressure tracings and their components during systole and diastole. It also describes normal and abnormal right atrial, right ventricular, pulmonary artery, and pulmonary capillary wedge pressure tracings, including how different disease states can affect the pressure waveform morphology. Various concepts in hemodynamic measurements are summarized such as timing of pressure waves, effects of respiration, and identifying features of common cardiac pathologies.
Central venous pressure (CVP) describes the blood pressure in the thoracic vena cava near the right atrium. Normal CVP ranges from 0-15 cm H2O depending on measurement point. CVP is affected by factors like volume status, respiration, and heart function. Central venous catheters are used to monitor CVP and administer IV medications and fluids long-term. Types include non-tunneled short term catheters and tunneled or implanted ports for longer term use. Nurses must properly insert, maintain, and discontinue central lines to prevent complications and ensure accurate CVP readings.
Central venous pressure (CVP) is the pressure measured in the central veins close to the heart and indicates right atrial pressure. CVP is measured using a catheter placed in a central vein that is connected to a manometer or pressure transducer. Normal CVP ranges from 1-7 mmHg or 5-10 cm H2O. CVP monitoring provides information about cardiac function and volume status and is used to guide fluid administration and assess patients' hemodynamic status. Complications of CVP monitoring include hemorrhage, pneumothorax, infection, and thrombosis.
Central venous lines and their problemsSunil Agrawal
The document discusses central venous lines and their placement and complications. It describes how central venous lines can be placed in the internal jugular, subclavian, femoral, and umbilical veins using the Seldinger technique. Potential acute complications include hematoma, cellulitis, arterial puncture, pneumothorax, malposition, and air embolism. Chronic complications include infection and thrombosis. The document recommends using antimicrobial-impregnated catheters, avoiding antibiotic ointments, not scheduling routine catheter changes, and removing catheters when no longer needed to help prevent complications.
The document discusses the nursing management of patients undergoing coronary artery bypass grafting (CABG) surgery. It covers preoperative, intraoperative, and postoperative nursing assessments, diagnoses, goals, and interventions. Key aspects of care include managing patients' fears and knowledge deficits, monitoring for complications during and after surgery, maintaining cardiac output and gas exchange, managing pain, and teaching patients about postoperative self-care.
The document discusses various methods of clinical hemodynamic monitoring in the intensive care unit (ICU), including arterial blood pressure monitoring, central venous pressure monitoring, and pulmonary artery pressure monitoring. It provides details on the indications, equipment, techniques, waveforms, and complications of invasive hemodynamic monitoring procedures like arterial line placement and central venous catheterization.
CVP digunakan untuk memantau tekanan vena sentral dan fungsi ventrikel kanan. Nilai normal CVP adalah 3-8 mmHg. Komplikasi yang dapat terjadi meliputi emboli udara, pneumotoraks, dan infeksi, namun dapat dicegah dengan teknik steril dan memantau tanda infeksi.
This document provides information about a seminar on hemodynamic monitoring presented by UMAdevi.k. It discusses the purpose of hemodynamic monitoring in critically ill patients, which is to continuously assess the cardiovascular system and diagnose/manage complex medical conditions. Specific techniques covered include arterial blood pressure monitoring, central venous pressure monitoring, and pulmonary artery catheter pressure monitoring. Key aspects of each technique like indications, equipment, procedures, nursing responsibilities, and potential complications are defined. Normal hemodynamic values are also provided.
This document provides information about central venous catheters and PICC lines, including their indications, contraindications, anatomy, insertion procedures, complications, and care. It discusses the internal jugular, subclavian, and femoral vein access sites and provides details on the Seldinger technique for catheter insertion. The roles of nurses in central line care including dressing changes, flushing, and preventing infections are also covered.
Vascular access in neonates small children dr. rasha helmyFarragBahbah
This document discusses vascular access options for hemodialysis in neonates and small children. Peritoneal dialysis is generally preferred but is not always feasible or effective. Central venous catheters provide adequate flow for dialysis but have high failure and complication rates. Arteriovenous fistulas, the preferred access for adults, are not usually possible in small children. Alternative options discussed include peripherally inserted central catheters and umbilical venous catheters. The risks and benefits of different vascular access sites like internal jugular, subclavian and femoral veins are also reviewed.
This document discusses peripheral and midline intravenous catheters. It notes that peripheral catheters are appropriate for short term therapies under 7 days through superficial hand or arm veins. Midline catheters are inserted further up the arm and can remain in place for 1-4 weeks, providing less frequent site changes than peripheral catheters. The document reviews best practices for catheter insertion, stabilization, dressing, and flushing to promote safe and effective venous access.
Central lines are catheters placed in large veins to allow delivery of fluids, drugs, and blood draws. They have multiple ports and are longer than typical IV lines. The document discusses types of central lines including PICCs, subclavian, internal jugular, and femoral lines. It describes parts of central lines and provides details on indications, site selection, insertion procedure including sterile precautions, positioning, and confirmation of proper placement. Potential complications are also summarized.
Central venous catheters (CVCs) are commonly used in critically ill children for medication administration, monitoring, and other purposes. The document discusses CVC insertion techniques and sites, including the internal jugular, subclavian, and femoral veins. Proper insertion involves strict sterility, ultrasound guidance when possible, local anesthesia, and confirming proper placement to avoid complications like bleeding, infection, and accidental arterial puncture.
This document discusses central venous catheters and their uses, types, insertion techniques, complications, and strategies to reduce infections. Central venous catheters are indwelling intravenous devices inserted into central veins for difficult vascular access, volume loading of medications or solutions, central venous pressure monitoring, and hemodialysis. Types include non-tunneled, tunneled, peripherally inserted central catheters, and implantable ports. Complications can be acute like hematoma or pneumothorax, or chronic like infections, thrombosis, and non-function. Infection is the most serious complication and strategies like hand hygiene and chlorhexidine skin preparation can reduce central line-associated bloodstream infections.
Peripheral intravenous catheters are used to provide venous access for blood sampling, fluid administration, medications, and other purposes. They involve inserting a small gauge cannula into a superficial vein in the arm or hand. Central venous catheters are longer catheters placed into larger central veins to administer irritating or large volume substances. Proper techniques like using ultrasound guidance and the Seldinger technique aim to safely place the catheter and minimize complications like infection, bleeding, or injury to surrounding structures. Ongoing care of the insertion site and catheter is also important.
Central venous access devices such as nontunneled central venous catheters and peripherally inserted central catheters can be placed under imaging guidance more safely than with external landmarks alone. Nontunneled catheters are commonly placed at the bedside using local anesthesia for temporary access when patients are too ill to transport. They provide advantages over tunneled catheters in that they do not require strict coagulation parameter adherence and can be easily removed. Proper placement of catheter tips is important to avoid complications and the superior vena cava-right atrial junction is the ideal target location.
Echocardiography, CSF study, IV and IM injectionszaid rasheed
This document provides information about pediatric echocardiography. It discusses what echocardiography is and its main indications including congenital heart disease, acquired heart disease, and arrhythmias. It describes common signs and symptoms of congenital heart disease. It also outlines the main types of echocardiography, including transthoracic and trans esophageal echocardiography.
This document discusses vascular access options for hemodialysis in children, including peritoneal dialysis, arteriovenous fistulas, synthetic grafts, and central venous catheters. Peritoneal dialysis is generally preferred for neonates and small children due to its simplicity compared to hemodialysis. Arteriovenous fistulas are the best long-term option but have a slow maturation process and risk of failure. Synthetic grafts have increased infection risks and expected lifespan of only 3-5 years. Central venous catheters are used for acute cases but carry risks of infection and thrombosis. Patient size, vascular anatomy, and dialysis needs must all be considered to determine the most appropriate access.
The document discusses guidelines for vascular access in hemodialysis patients. It states that patients with advanced chronic kidney disease should be referred for evaluation and planning of arteriovenous access before needing dialysis. Short-term catheters should only be used for acute dialysis or limited hospital use, while long-term catheters require a plan for permanent access. Catheter choice depends on goals, experience, and cost. The risks and benefits of different types of catheters are also summarized.
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)
This document provides an overview of invasive procedures including peripheral venous cannulation, central lines, arterial lines, and intraosseous infusion. It discusses indications, contraindications, equipment needed, and techniques for each procedure. Complications are also reviewed. Key points include choosing the appropriate cannula size based on intended use, selecting sites that provide optimal venous access, using sterile technique to minimize infection risk, and being prepared for emergencies by having the skills for intraosseous infusion when intravenous access cannot be quickly obtained.
This document discusses congenital heart defects, including atrial septal defects (ASD) and ventricular septal defects (VSD). It notes that congenital heart defects are caused by abnormal embryonic development and occur in approximately 1 in 125 births. ASDs and VSDs allow abnormal blood flow between the left and right sides of the heart and can cause heart failure if left untreated. They are typically repaired via catheterization or open heart surgery between ages 4-6 months. Post-operative care involves monitoring for complications and administering medications.
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 summarizes endovascular treatment options for large and giant cerebral aneurysms 15mm or larger. It discusses techniques like parent vessel occlusion with coils or balloons, selective coil occlusion with or without supporting devices, and occlusion with Onyx. Factors like aneurysm location, size, and anatomy determine the best approach. Internal carotid artery occlusion is commonly used for cavernous aneurysms. Vertebral and basilar trunk aneurysms can now often be treated with selective coiling and stenting rather than parent vessel occlusion. Bypass surgery is rarely needed preceding endovascular parent vessel occlusion.
1. CVAD & Advanced Haemodynamic
Monitoring
Eamon Merrick RN, BHSc UTS (NZ) MHSM UTS
Jane Currie NP, BSc City(UK) MScS'ton, RAANC
SYDNEY NURSING SCHOOL
2. Outcomes
› This lecture will:
• introduce Central Venous Access Devices (CVAD), arterial lines (a or art-line),
and invasive haemodynamic monitoring
• overview the indications, management, and potential complications of CVAD/
arterial lines
• discuss the principles of invasive haemodynamic monitoring
• review your role in the safe management of patients with CVAD/ arterial lines
2
3. Definition
› Central Venous Access Device (CVAD)
• A catheter introduced via a large vein into the superior vena cava or right
atrium for the administration of parental fluids, medications, or for the
measurement of Central Venous Pressure (CVP)
- 15-20cm long single or multipurpose catheter
- Multiple lumens with multiple openings along the length of the catheter-
proximal, medial, and distal.
3
4. Basilic and Femoral Insertions
› Peripherally Inserted Central Venous Catheter (PICC)
› Tend to be used for long-term access
› Inserted into the cephalic, basilic, or brachial (cubital?)
- Minimal risk of pneumothorax or vessel perforation during
insertion
- Durable and flexible
- Less risk of infection
- Vigorous exercise (swimming) should be avoided
- Infusion pump should be used due to lumen size
4
5. Where are you likely to encounter CVAD
› There is a good chance that you will care for a patient with a CVAD if you
work in a critical care setting i.e. emergency or intensive/ critical care- also
likely in oncology settings
5
6. Why?
› When might it be useful to have a CVAD?
- Remembering they are introduced via a large vein into the superior vena cava or
right atrium.
6
7. Indications
› Administration of fluid
› Monitoring of hydration status
› Monitoring of cardiac status
› Difficulties in finding alternative intravenous access
› Monitoring the effects of cardio-active agents i.e. inotropes, vasodilators
› Administration of potent medications
› Administration of Trans-Parental Nutrition (TPN)- why?
› Haemodialysis
7
8. Insertion Points
› Internal Jugular
- Preferred site- improve chances of placement success and less risk of
complications
- Easiest access with the shortest and straightest route
- Less risk of injury to the vagus nerve and carotid artery
Although… increase risk of occlusion and irritation due to head movement
and problems with maintaining a intact dressing.
8
10. External Jugular and Subclavian
› External jugular
Easy insertion
Varies from person- person in size
Angles into the subclavian (bendy insertion)
Subclavian
Preferred for long-term
Less vessel irritation and risk of occlusion due to rapid flow
Secures to chest wall
Potential for superior vena cava obstruction
Complications include pneumothorax an thrombosis
10
11. External Jugular, Subclavian, Brachiocephalic
(innominate), Superior vena cava
External Jugular
Subclavian
Brachiocephalic
Superior vena cava
11
12. Basilic and Femoral Insertions
› Basilic
Usual site for the insertion of PICCs due to the shortest and straightest of the vein
Femoral
Good approach for children- tip rests in inferior vena cava
Increase risk of thrombosis and infection
12
14. Insertion and Management/ Risk Factors
› Anxiety
› Obesity
› Coagulopathy
› Anti-platelet medications
› Hypotension
› Proximal surgery
› Previous CVAD at site
› Infection at site
› Lymph node dissection or removal
› History of DVT in limb
› Pulmonary of pulmonary catheter- left bundle branch block
14
15. Catheter Selection
› Planned approach based on the individual needs of the patient
- Minimise the number of lumens (why?)
- Should anti-microbial catheters be used?
- Multiple infusions and TPN, why is this a consideration?
- How long will the CVAD be insitu?
- Will this be a out-patient?
15
16. Review- Central Venous Access Devices
› Central lines
- 15-20cm long single or multipurpose catheter
- Multiple lumens with multiple openings along the length of the catheter- proximal,
medial, and distal.
- Used for:
- Alternative of peripheral access
- Administration of IV Fluids
- Administration of IV medications
- Administration of Trans-Parental Nutrition (TPN)
- Monitoring of Central Venous Pressure (CVP)
16
17. Central Venous Access Devises- Complications
› During Insertion
- Pneumothorax- can occur with subclavian and jugular approaches where the
plural cavity is punctured
- Haemorrhage- damaged vessel on insertion (patients with coagulopathies/
thrombocytopenia are at more risk)
- Air embolism
- Cardiac tamponade- Poor placement of the catheter tip can result in a puncture
or swelling of the myocardium
- Dysrhythmias- due to a irritation of the right atrium
17
18. Central Venous Access Devises- Complications
› Post-Insertion
- Air embolism
- Occlusion/ Thrombosis- inadequate flushing can result in a build up of fibrin or
medication particulate- think incompatible medications
- Infection- contamination at time of insertion, insertion site or lumen, and/or the
giving set.
- Pain- potentially indicative of poor placement and infection
- Dislodgement- normally accidental (not always)- what would do in this situation?
18
19. Central Venous Access Devises- Removing
› Removal
- Aseptic technique
- Consider the individual needs of the patient
- Patient in a supine position with head tilted down- why?
- Patient to remain in a supine position for 30- 60 minutes
- Document removal and note presence (or otherwise) of intact tip
- Blood cultures and culture of tip if infective process suspected
19
20. Preventing Occlusion
How can nursing professionals prevent the occlusion of a CVAD?
› Matthew, D., Mitchell, B. J. A., Williams, K., & Umscheid, C. A. (2009). Heparin flushing and other interventions to maintain
patency of central venous catheters: a systematic review. Journal of Advanced Nursing, 65(10), 2007-2021.
20
21. Preventing Infection
How can nursing professionals prevent infection/ sepsis in patients with a
CVAD?
› New South Wales Health Department of Health. (2011). Central venous access device insertion and post insertion care.
Sydney.
› Australian New Zealand Intensive Care Society. (2012). Central Line Insertion and Maintenance Guideline: ANZICS Safety
and Quality Committee. Available from:
http://www.anzics.com.au/downloads/doc_download/649-anzics-central-line-insertion-a-maintenance-guideline-april-2012
21
22. Air Embolism
Identify:
Sudden onset of cyanosis
Tachypnoea
Coughing
Tachycardia
Hypotension
22
23. Air Embolism
Act:
Clamp the line
Turn the patients head to the opposing side of the line
Lie the patient flat on her/his left hand side
Get help!
Ask the patient to perform the ‘Valsalva’ manoeuvre (if conscious)
Goal:
Immediate medical management- possibly requiring aspiration, mechanical
ventilation (100% O2), and pharmacologic circulatory support.
23
25. Central Venous Pressure (CVP)
Continuous monitoring of of the pressure of blood in the right atrium or superior
vena cava
Best interpreted as a trend- the cardiac function of the patient must be considered
Useful for estimating right ventricular pre-load- not systemic pressure/ perfusion
Remember that left-sided output determines systemic pressure and perfusion
25
26. Central Venous Pressure (CVP)
› Raised CVP may indicate
- Right ventricular failure
- Cardiac tamponade
- Tricuspid valve incompetence
- Infusions in progress
- Catheter tip that is occluded or displaced
26
27. Central Venous Pressure (CVP)
› Depressed CVP may indicate
- Ascites
- Vasodilation of peripheral veins
- Vasodilating medications
- Decrease circulatory blood volume (hypervolemia, dehydration)
27
30. Arterial Lines
Allows:
The invasive real-time monitoring of blood pressure
useful when administering inotropic or cariotropic medications
The drawing of blood gases
The calculation of Mean Arterial Pressure (MAP)
The assessment of compromised aortic valves
Garretson, S. (2005). Haemodynamic monitoring: arterial catheters. Nursing Standard, 19(31), 55-64.
Watson, C. A., & Wilkinsin, M. B. (2011). Monitoring central venous pressure, arterial pressure and pulmonary wedge
pressure. Anesthesia and Intensive Care Medicine, 13(3), 116-120.
30
31. Modified Allens Test
Checks the patency of the radial and ulnar
arteries
Preformed prior to and post insertion of a arterial
line
1. Elevate the hand and make a fist for 30
seconds
2. Apply pressure to both the ulnar and radial
arteries
3. The hand is opened and should appear
blanched
4. Release pressure on the ulnar artery and
check for refill
31
35. Mean Arterial Pressure
Mean Arterial Pressure (MAP) is the pressure felt by the internal organs- it is not
an average… as the duration of diastole exceeds that of systole
A MAP of at least 60mmHg is required to perfuse the coronary arteries, brain and
kidneys.
A ‘normal’ range is about 70mmHg to to 110mmHg
((2 ´ diastolic) + (systolic))
3
35
CVADs are placed in large vessels to permit frequent, continuous, or intermittent therapy- avoiding multiple venipunctures. For example the sub-clavian or jugular vien.CVADs are useful for the administration of drugs that are vesicants, blood products, and parenteral nutrition.The major benefit of CVADs is that they can allow for central haemodynamic monitoring and reduce the risk of extravasation- however they lead to an increased risk of systemic infection.PICCs- inserted into a vien in the arm rather than the neck- can be used from one to six months. PICCs tend to lead to lower infection rates- however phlebitis cans occur (usually 7-10 dys after insertion).
Also known as long-lines- identify each of the veins and identify the ‘cubital fossa’
Include: cancer (because chemo tends to be irritating of vesicant), infections (for the long-term administration of antibiotics), nutritional replacement (because it is possible to infuse higher concentrations of dextrose than in PVC’s), Renal failure (for heamodyalsis [especially acute] or continuous renal replacement therapy), Shock (able to infuse high volumes of fluids and electrolytes).
At the base of the neck the internal jugular joins with the subclavian vein- and the joins the brachiocephalic vein which descends to the superior vena cavaCan any tell me what the name is of this other vein (external jugular)
In this case long term means no more than 14 days- a recent study of 850 patients has demonstrated that pt’s tend to become pyrexic at 13.4 days- which means what? Infection!!!!!!!!!
Draw in connectors - have students suggest
At this point have two students come up and demonstrate the location and route of the PICC and CVC based on whomever is holding it at the time- see if they insert to the Left side or the right sideHave the students then discuss what some of the considerations may be for their nursing care if ask to assist with the insertion of CVD
Discuss why each of these points are important
Other types and names you will come across:PICC Lines – what are these useful for?Hickman's- used for long-term access (chemo)- lines should be hep locked and clamped to prevent air embolism- blood back flowPortocaths- Implanted device- useful for blood products long term TPN- access through a needle into the skin- talk about creepy this is
Sometimes on insertion patients will complain of a swishy noise- normally with a jugular placement – whyAlways confirm placement by xray
Ask the students to identify how they will reduce the risk of infection
What are some of the individual needs of patients- think about the ability of the patient to tolerate the supine positionIs this patient on anti-coagulatants is he/she wafarinised? I so what are the chemical indicators to check prior to removal- Internationalised Normalised Ratio (INR)- INR in absence of anticoagulation therapy is 0.8-1.2. The target range for INR in anticoagulant use (e.g. warfarin) is 2 to 3. In some cases, if more intense anticoagulation is thought to be required, the target range may be 2.5-3.5.[1]What would do if the tip is not present?How might you be able to tell if there is a infective process?
The most likely complication
Can occur if the catheter is unclamped and cap is removed!The immediately life threatening complication!!!!
Can occur if the catheter is unclamped and cap is removed!Place the patient on her/his left hand side- keeping the air in the apex of the right ventricle and (hopefully) preventing the air from entering the pulmonary circulationValsalve increases intrathoraic pressure and can slow the heart rate- try it nowMechanical ventilation with 100% oxygen, positive end-expiratory pressure, pharmacologic circulatory support, and external cardiac massage may be required
A normal CVP reading in a spontaneously breathing patient is 5-10 cmH2O. However, as stated earlier, its value is influenced not only by intravascular volume and venous return, but also by venous tone and intrathoracic pressure, along with right heart function and myocardial compliance.
A normal CVP reading in a spontaneously breathing patient is 5-10 cmH2O. However, as stated earlier, its value is influenced not only by intravascular volume and venous return, but also by venous tone and intrathoracic pressure, along with right heart function and myocardial compliance.
A= atrial contractionC= bulging of the tricuspid valveX= Atrium relaxes and tricuspid is pulled downV= Passive filling of right atrium and vena cava when tricuspid closesY= tricuspid valve opens and blood flows into right ventircleNo a wave= atrial fibilationHeart block = cannon waves, nodal waves (look like big a waves)
Wiggers diagram- Dr Carl Wiggers from the university of MichiganIdentify each waveformTop grey Aortic pressure curve is the what we see on the arterial pressure waveform- top line grey----Dicrotic notch corresponds with the closure of the aortic valveBlue The LV waveform- look a the variation in diastole it is about 10mmhg- during contraction it goes up to 120mmhg in a normal adult- remember that the L ventricle Is how blood gets to our body- blue lineMiddle grey- Arterial pressure is the pressure within the atria- note that operates under much less pressure- grey middleRed line- Venticular volume shows the filling and empty of the venticles.ECG- importantly the events on the ECG occur just before the events on the other curves- because to have contractions you first have to have conductionWhat is systole= ejection from the ventriclesWhat is diastole= ventricular filling- look at the redventricular volume line and note how it is gradually increasingInsert first yellow box- this is contractionNote the P wave on the ECG- this gives the atria a kick- and accounts for 15-20% of venticular volume- which we can see on the red ventricular volume lineMove to the R wave on the ECG this cases venticular contraction- the pressure in the venticules exceeds that of the atria- which we can see on the ventricular pressure line- pressure is building very fast in the ventricles but the blood has nowhere to go because both the mitral and aortic valves are closed- have a look at the notch on the arterial pressure line- that is the pressure being exerted on the valve (no regugitation)- pressure builds in the ventricle and overcomes the aortic pressure – normally at 80mmhg or the diastolic pressure- it is at this point that the aortic valve opensInsert 2nd yellow box- End of systole - relaxation- note on the ventricular pressure line that the pressure keeps down until the end of relaxationAt the beginning of relaxation aortic pressure again exceeds that of ventricular pressure (aortic pressure and ventricular pressure lines) at this point the the aotic valve closes- it is at this moment that the dicotic notch appears – think of this a a rebound the blood is trying to go somewhere but as the aortic valve closes it bounces up and off causing a brief bump in the arterial pressure wave form- look at the aterial pressure line and you will note that the aortic notch occurs at the exact moment of aortic valve closure (artia pressure increases because the blood has nowhere to go) – the diacrotic notchAs the the LV empties the atria are filling – we then enter diastole where the ventricles begin to fill again
Aterial lines are often inserted in the the (what side) LEFT radial artery
Allens test is performed to check distal perfusion- should there be a complication from the placement of the arterial line the distal blood flow will be maintained by the alternate artery- although there is limited evidence to suggest the utility of the Allen's test prior to arterial line placement because o f the small number of people who have only one patent supply it is useful for nursing professionals who wish to check the distal circulation of a patient who has a arterial line- checking for occlusionsIf the palm remains pale a radial puncture cannot be performed!Identify that the ulnar is the proximal artery and radial is distal and the long vein in the back is the basilic vein- CVAD
The risks are much the same as CVADs however there is one important thing to note necrosis! Never under any circumstances should you administer a medication via a art line!One other major difference is that a hemorrhage is likely to bleed out- how do you know that this is a arterial bleed?What do you do-Take universal precautions (wear sterile gloves, goggles and gown)Ensure there are no hazardous objects in the woundUse one finger, with interposed gauze, to press directly on the bleeding vessel just proximal to the bleeding pointCall for help!Maintain this for 10 minutesOnce controlled – apply the up-side-pyriamidThe occluding finger should be substituted with a dental roll or tightly folded “nugget” of gauze.A tourniquet may be temporarily applied proximally to facilitate this.Once the positioning is correct and no further bleeding is occurring, slightly larger or less folded pieces of gauze can be placed one on top of the other, creating an inverted pyramid of gauze.The layers of gauze are secured with a loose bandage. Only very light pressure need be applied to the top layer of gauze to maintain hemostasis, as the pressure is “focused” onto the bleeding point. This technique is based on the equation: Pressure=Force/AreaThe tightness of the bandage can be judged from the amount of pressure needed to maintain hemostasis when applying the top layer of gauze.
Top grey Aortic pressure curve is the what we see on the arterial pressure waveform- top line grey----Dicrotic notch corresponds with the closure of the aortic valvegraph of aortic pressure throughout the cardiac cycle displays a small dip (the "incisure" or "dicrotic notch") which coincides with the aortic valve closure. The dip in the graph is immediately followed by a brief rise (the "dicrotic wave") then gradual decline. Just as the ventricles enter into diastole, the brief reversal of flow from the aorta back into the left ventricle causes the aortic valves to shut. This results in the slight increase in aortic pressure caused by the elastic recoil of the semilunar valves and aorta.DRAW IN THE Ventricular PRESSURE WACW FORM
The risks are much the same as CVADs however there is one important thing to note necrosis! Never under any circumstances should you administer a medication via a art line!Back to previous slide and illustrate where MAP sits
Ask students to identify diastole systole contraction relaxation and the dicrotic notch