Vascular Access
description
Transcript of Vascular Access
![Page 1: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/1.jpg)
Vascular Vascular AccessAccess
![Page 2: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/2.jpg)
I.S.
MD
oA 2-month-old girl arrives at the Emergency Department in cardiac arrest. Other providers promptly begin ventilation and perform chest compression. You need to establish vascular access to administer fluids and medications
![Page 3: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/3.jpg)
I.S.
MD
oWhat is the optimal site for immediate vascular access for this infant?
o If resuscitative efforts are successful, what is the optimal site for vascular access during the post resuscitation period?
![Page 4: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/4.jpg)
I.S.
MD
Objectives
o Prioritize sites of vascular access for different clinical circumstances
o Describe the risks and benefits of peripheral venous, central venous, and intraosseous vascular access
o Describe the IO access technique
![Page 5: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/5.jpg)
I.S.
MD
Selection of site and priorities of vascular access 1
For CPR and treatment of decompensated shock the one that is
o most readily accessibleo not require interruption
![Page 6: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/6.jpg)
I.S.
MD
Selection of site and priorities of vascular access 2
oCompensated shock… large bore peripheral IV catheter
oPost resuscitation phase… central venous catheter
o Intracardiac administration of drugs during closed chest compression
oArterial cannulation
![Page 7: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/7.jpg)
I.S.
MD
Priorities of Vascular Access
oDuring pediatric CPR or treatment of decompensated shock.. IO access
oOne practical approach: IO or peripheral or central access simultaneously
oDuring attempted resuscitation.. Transtracheal …LEAN
![Page 8: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/8.jpg)
I.S.
MD
Intraosseous Access
o Provides access to a noncollapsible marrow venous plexus which serves as a rapid , safe and reliable route of administration
o Often can be achieved in 30-60 seconds by using a rigid needle(specially designed or Jamshidi-type)
![Page 9: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/9.jpg)
I.S.
MD
Intraosseous Access
o A rapid, safe, & effective route for the administration of medications & fluids, & may be used for obtaining an initial blood sample for type & crossmatch & for chemical & blood gas analysis even during resuscitation (Class IIa; LOE 3).
o Acid-base analysis is inaccurate after sodium bicarbonate administration via the IO cannula.
![Page 10: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/10.jpg)
I.S.
MD
Intraosseous Access
o Epinephrine, adenosine, fluids, blood products, & catecholamines can safely be administered.
o Onset of action & drug levels achieved are comparable to venous administration.
o Use manual pressure or an infusion pump to administer viscous drugs or rapid fluid boluses, & follow each medication with a saline flush to promote entry into the central circulation.
![Page 11: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/11.jpg)
I.S.
MD
Intraosseous Access
![Page 12: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/12.jpg)
I.S.
MD
Intraosseous Access
![Page 13: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/13.jpg)
I.S.
MD
Intraosseous Access
![Page 14: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/14.jpg)
I.S.
MD
Intraosseous Access
![Page 15: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/15.jpg)
I.S.
MD
Complications
o Complications reported in fewer than 1%o Fracture of Tibiao Lower extremity compartment syndrome o Osteomyelitiso Extravasation of Drugs
![Page 16: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/16.jpg)
I.S.
MD
Central V/S Peripheral Venous Access
o More secure long-term accesso Not higher drug levels or a substantially
more rapid responseo Administration of drugs could injure
tissues(vasopressors ,calcium ,sodium bicarbonate)
![Page 17: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/17.jpg)
I.S.
MD
Complications of central venous cannulation
o Local and systemic infection,venous or arterial bleeding, arterial cannulation, Thrombosis,plebitis, pulmonary thromboembolism,hydro pneumo hemo chylo thorax, cardiac tamponade, arrhythmias, air embolism, catheter fragment embolism
![Page 18: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/18.jpg)
I.S.
MD
Peripheral Venous Access Devices
o Over-the-needle catheterso Catheter-over-wire deviceso Catheter-through-introducing sheath
deviceso Butterfly needles
![Page 19: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/19.jpg)
I.S.
MD
Peripheral Venous Access
![Page 20: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/20.jpg)
I.S.
MD
Peripheral Venous Access
A tourniquet is placed around
the infant's head & the needle
inserted 0.5 cm from the intended
puncture site in the direction of
blood flow.
![Page 21: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/21.jpg)
I.S.
MD
Peripheral Venous Access
![Page 22: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/22.jpg)
I.S.
MD
peripheral Venous Access
![Page 23: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/23.jpg)
I.S.
MD
Peripheral Venous Access
![Page 24: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/24.jpg)
I.S.
MD
Peripheral Venous Access
![Page 25: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/25.jpg)
I.S.
MD
Central Venous Access
![Page 26: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/26.jpg)
I.S.
MD
External Jugular cannulation
![Page 27: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/27.jpg)
I.S.
MD
Subclavian approach to central vein
![Page 28: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/28.jpg)
I.S.
MD
Central Venous AccessApproach to Femoral Vein
![Page 29: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/29.jpg)
I.S.
MD
Venous Cutdown
![Page 30: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/30.jpg)
I.S.
MD
Venous Cutdown
![Page 31: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/31.jpg)
I.S.
MD
Venous Cutdown
![Page 32: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/32.jpg)
I.S.
MD
Venous Cutdown
![Page 33: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/33.jpg)
I.S.
MD
Mini-cutdown
oThe vessel is elevated with a hemostat & occluded with gentle traction from a distal tie. oThe needle is inserted & the sheath is advanced into the vessel. oThe vessel should not be tied off with this technique.
![Page 34: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/34.jpg)
I.S.
MD
Arterial Lines
![Page 35: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/35.jpg)
I.S.
MD
Arterial Lines
![Page 36: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/36.jpg)
I.S.
MD
Summary points
oIntravascular or intraosseous access is the preferred route for medication and drug delivery in cardiopulmonary emergencies.
![Page 37: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/37.jpg)
I.S.
MD
2
o Immediate intraosseous access is recommended in cases of decompensated shock and cardiopulmonary arrest, particularly if the provider lacks experience in pediatric central venous access techniques
![Page 38: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/38.jpg)
I.S.
MD
3
oCentral venous catheterization can be used in children in emergencies. But it requires significant expertise. Many complications and delays may occur in expert hands
![Page 39: Vascular Access](https://reader035.fdocuments.us/reader035/viewer/2022081504/5681502a550346895dbe1a05/html5/thumbnails/39.jpg)
I.S.
MD
QUESTIONS???