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.

1. Vascular AccessMary Corcoran RN, BSN, MICN

2. Peripheral Access

3. Tips and TricksPeripheral Access is obtained using Aseptic technique

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

9. Scalp Veins have no valves and are easily visible on infants- allowing infusion in both directionsInfiltration of fluid or medication (can cause necrosis with certain meds)PhlebitisEmbolismOf blood, air, or catheter fragmentsInfectionCellulitisNeedle stick and blood exposure for RNPotential Complications

10. In ER- anywhere you can find a veinArms, legs, Neck, Abdomen, Hands, Feet, Breasts etc…Most Common areHands, 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 protocolsLocation

11. Size and Type of cath are determined by urgency of need, patient size and vasculatureLarger Diameter (12,14,16,18g)- used for rapid fluid, drug, or blood infusionSmaller Catheter (20,22,24g)- are used for routine vascular access, and patients with smaller veinsCatheter Selection

12. IV Insertion

13. Central Venus Access

14. Subclavian Vein- under the clavicleInternal Jugular- also under the clavicle Femoral Vein- In the groinWhere are they placed?

15. Why do we place them?Short TermWhen all other peripheral access is unavailableWhen condition is unstable and requires hemodynamic monitoring (eg CVP)Prolonged IV TherapyTPN, extended Abx therapy, or caustic medication administration VancomycinDebilitating diseases AIDS, CancerLong Term

16. Central Line Insertion

17. Venus Access Devices

18. Intraosseous Infusion

19. Inserted in to the bone marrow, blood can be drawn from the marrow, and fluids, medication, and blood infused through the marrowUsed on adults and pediatric patientsWhen all else fails…

20. Anterior Tibia, Medial Malleolus, Sternum, Distal Femur, Humerus, or Iliac CrestWhere 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

24. Maintenance IV Fluid

25. Whole BloodUnfiltered and carries significant risks of infection and transmission, is expensive, and not readily availablePRBC’s (Packed Red Blood Cells)Are used most often for blood replacementFFP (Fresh Frozen Plasma)Contains Clotting FactorsAlbumin (5% isoonocoit, 25% isotonic “salt poor”)Used as volume expander when risk of interstitial edema is great (pulmonary/cardiac disease)Blood Administration