1. Vascular Access Mary Corcoran RN, BSN, MICN

2. Peripheral Access

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

13. Central Venus Access

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

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 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

24. Maintenance IV Fluid

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

26. Blood Compatibility

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