Vascular access
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This document provides an overview of vascular access including peripheral access, central venous access, and intraosseous infusion. It discusses tips for obtaining peripheral access as well as potential complications. Common sites for peripheral access are noted. Factors such as urgency, patient size, and vasculature are discussed in selection of catheter size and type. Reasons for central line placement include unstable conditions, prolonged IV therapy, and long-term access needs. Intraosseous infusion is described as an alternative when other access is unavailable. Blood products and transfusion reactions are also summarized.
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The document summarizes techniques and complications of arteriovenous (A-V) fistulas used for hemodialysis. It discusses types of fistulas including autogenous and graft fistulas. It describes surgical techniques for creating different types of fistulas such as side-to-side, end-to-side, and end-to-end anastomoses. Common complications include early failure from thrombosis, aneurysm formation, infection, ischemic changes causing steal syndrome, and venous hypertension. Care of the fistula involves exercises and avoiding blood pressure checks or intravenous lines in the fistula arm.
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- Long-term catheters should be used with a plan for permanent access and prefer those capable of high flow rates. Choice depends on local experience and goals.
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The document summarizes techniques and complications of arteriovenous (A-V) fistulas used for hemodialysis. It discusses types of fistulas including autogenous and graft fistulas. It describes surgical techniques for creating different types of fistulas such as side-to-side, end-to-side, and end-to-end anastomoses. Common complications include early failure from thrombosis, aneurysm formation, infection, ischemic changes causing steal syndrome, and venous hypertension. Care of the fistula involves exercises and avoiding blood pressure checks or intravenous lines in the fistula arm.
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An arteriovenous fistula (AVF) is created by surgically connecting an artery directly to a vein, allowing blood to flow from the artery to the vein. This creates a continuous circuit from the heart. The most common sites for AVFs are the wrist, elbow, and upper arm.
Cannulation of the AVF is important to maintain patency and prevent complications. It can be done using either a rope ladder technique, which rotates sites, or a buttonhole technique, which uses the same site. Proper needle size, angle, and hemostasis are important to prevent issues like infiltration or bleeding.
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This document discusses vascular access for hemodialysis. It describes the different types of access including fistulas, grafts, and catheters. Fistulas are the preferred type as they last longest and have lowest risk of complications. Grafts are also used but have shorter lifespan. Catheters are not ideal for permanent access but can be used immediately while other access matures. The document outlines how to place and care for each type of access. Complications of catheters include higher risk of infection due to direct bloodstream access. Proper placement of catheter tips in the superior vena cava or right atrium is also discussed.
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For an AVF to be suitable for cannulation and dialysis, it must undergo a maturation process where the fistula develops adequate blood flow, wall thickness and diameter. A properly matured fistula will have a minimum diameter of 6mm, be less than 6mm deep, have a blood flow over 600ml/min, and be evaluated at 4-6 weeks after creation.
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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.
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This document discusses complications of central venous catheters including infection, occlusion, and thrombosis. It provides details on definitions, risk factors, treatments, and outcomes for each complication. Central line-associated bloodstream infection is the most common complication, occurring in 1.3-1.5 per 1000 catheter days. Occlusion can often be treated by restoring patency with thrombolytics or other methods in over 70% of cases without needing catheter replacement. Venous thrombosis is another significant complication that requires proactive treatment to preserve central vein access long term.
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A review of Best Practices in Vascular Access and Infusion Therapy presentati...
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Vascular access
- 1. Vascular Access Mary Corcoran RN, BSN, MICN
- 4. Initial insertion attempts should begin distally and progress up the extremity
- 5. If the situation and pt vasculature allow
- 6. During resuscitation peripheral access is preferred to eliminate interruption in chest compression for central line insertion
- 7. Proximal veins may be used when giving medication with extremely short half life, or for rapid fluid or CT contrast infusion
- 8. Adenosine
- 10. In ER- anywhere you can find a vein Arms, legs, Neck, Abdomen, Hands, Feet, Breasts etc… Most Common are Hands, A/C (antecubital), Forearms, and EJ’s (external Jugular) Just make sure to always point toward the heart **note: check with your facility for specific locations and protocols Location
- 11. Size and Type of cath are determined by urgency of need, patient size and vasculature Larger Diameter (12,14,16,18g)- used for rapid fluid, drug, or blood infusion Smaller Catheter (20,22,24g)- are used for routine vascular access, and patients with smaller veins Catheter Selection
- 12. IV Insertion
- 14. Subclavian Vein- under the clavicle Internal Jugular- also under the clavicle Femoral Vein- In the groin Where are they placed?
- 15. Why do we place them? Short Term When all other peripheral access is unavailable When condition is unstable and requires hemodynamic monitoring (eg CVP) Prolonged IV Therapy TPN, extended Abx therapy, or caustic medication administration Vancomycin Debilitating diseases AIDS, Cancer Long Term
- 19. Inserted in to the bone marrow, blood can be drawn from the marrow, and fluids, medication, and blood infused through the marrow Used on adults and pediatric patients When all else fails…
- 20. Anterior Tibia, Medial Malleolus, Sternum, Distal Femur, Humerus, or Iliac Crest Where do we place them?
- 21. You Tube Video for Humeral IO, staring someone familiar…..
- 22. Sternal IO insertion- only done in military currently
- 23. Fluid and Blood Replacement
- 25. Whole Blood Unfiltered and carries significant risks of infection and transmission, is expensive, and not readily available PRBC’s (Packed Red Blood Cells) Are used most often for blood replacement FFP (Fresh Frozen Plasma) Contains Clotting Factors Albumin (5% isoonocoit, 25% isotonic “salt poor”) Used as volume expander when risk of interstitial edema is great (pulmonary/cardiac disease) Blood Administration
- 27. Transfusion Reactions Hemolytic Cause- Blood Incompatibility Prevention- Type and Crossmatch, infuse first 50cc slowly Assessment- Fever, Chills, Dyspnea, Tachypnea, fever, olguria, hematuria, chest tightness Collect blood and urine Intervention- Discontinue Immediately FATALITY may occur after 100cc, start NS or LR, consider diuretics, and monitor BUN, Creatinine
- 28. Transfusion Reaction Allergic Cause- Antibody Reaction to allergens Prevention- Screen donors for allergy; administer antihistamines (Benadryl) prior to transfusion Assessment- Chills, hives, wheezing, vertigo, Anaphlaxis, dyspnea, bronchospasm and generlized edema Intervention- Stop Infusion, give antihistamines, epi, NS or LR
- 29. Transfusion Reactions Circulatory overload Cause-infusion of large amounts of blood, especially to elderly, or cardiac hx Prevention- Infuse Slowly; check drip rate and frequency Assessment- Pulmonary Crackles, Cough, dyspnea, pulmonary edema, increased CVP Intervention- Stop infusion, treat pulmonary edema
- 30. Transfusion Reaction Hypocalcaemia Cause-Precipitate from acid citrate dextrose calcium dilution with massive transfusions Prevention- use blood immediately Assess- Numbness, and tingling to extremities Intervention- Stop infusion, give Calcium Hyperkalemia Cause- Hemolysis of red blood cells Release Potassium Prevention- Use blood immediately Assess- Nausea, Vomiting, Muscle weakness, bradycardia Intervention- stop Infusion