2019 oweek - pivc - wslhd
TRANSCRIPT
20-Mar-19
1
VP/PIVC
Insertion
2019
1
Anthony Marshall
CNC Vascular Access, Westmead
Page 9248
Content Indications
Considerations & Contraindications
Complications
Anatomy & Physiology
Vein Selection
Equipment
Procedure
Trouble Shooting/First Aid
Summary
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0
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2
3
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56 7 8
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3.5Human body
cannot sustain life
5.8Cancer cells
begin to form
6.8Disease
symptoms begin
★7.35-7.45
Ideal blood pH
TimentinCephazolin Penicillian
ACID ALKALINE
9.8Human body
cannot sustain life
8.5Disease
symptoms begin
Vancomycin Dilution Challenge
• Attempting to dilute an infusate with an extreme pH is volume prohibitive. The best option is hemodilution
• So how much dilution?X 20
• 1gram of Vancomycin reconstituted in
20mL sterile H20 = pH 3
• How much dilution will it take to
bring this 1gram dose to a peripheral
vein friendly pH of 6?• 20mL + 180mL = pH 4
• 20mL + 1980mL = pH 5
• 20mL + 19880mL = pH 6
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Size Matters- Bigger is Better
Vessel Diameter Flow
Digital/Metacarpal Veins
2-5mm 20ml/min
Forearm Cephalic/Basilic
Veins
6mm 40ml/min
Basilic Upper Arm Vein
10mm 95ml/min
Axillary Vein 16mm 333ml/min
Subclavian Vein 19mm 800ml/min
SVC 20mm 2000ml/min
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Considerations
• Clinical indications for PIVC• Alternatives have been considered• Benefits outweigh the risks!!!• Check pt:
• ID & allergies• obtain verbal consent• The rate at which fluid will be administered.
(indication/expected duration)• Position of patient during planned procedures• Size and condition of patients veins.• Present or Past medical history. (Renal, lymph node
dissection, mastectomy, CVA, injury or infection)• Non dominant and avoid certain area’s
Complications of IV
Therapy
Systemic complications
COMPLICATIONS
Local complications
Phlebitis
Haematoma
Infiltration
Extravasation
Thrombosis
Septicaemia - SAC 2
Pulmonary Oedema
Speed Shock (rapid infusion)
Anaphylaxis (allergic reaction)
Pulmonary Embolism e.g Thrombosis
8Braun Introcan Safety (2009)
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PIVC Size and IndicationColour Gauge Ext Dia x
length (mm)Flow Rate (mL/min)
Yellow 24 0.7 x 19 23
Blue 22 0.9 x 25 36
Pink 20 1.1 x 32 40
Green 18 1.3 x 45 75
Grey 16 1.7 x 45 150
Orange 14 2.1 x 45 300
Triple Lumen CVC
16 7.5 Fr x 150 50
Site SelectionBest site for cannulation
•Cepahalic vein
(forearm)
Avoid unless necessary
•Anticubital fossa
•Digital
•Check site
•Apply tourniquet
•Vein should be round,
firm, flexible & full
•Ask for assistance if
uncertain if appropriate
site not found
•Release tourniquet
•Determine need for
topical or local
anaesthetic
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Equipment� Eye protection and PPE
� Protective Blue sheet
� Disposable tourniquet
� Soluprep (chlorhexidine gluconate with alcohol)
� Cannulation pack
� Sterile gloves
� Cannula & Cannula Cap – “bung”
� Extension tubing
� Blunt drawing up needle/Syringe
� N/Saline
� Topical or local anaesthetic if indicated
� Date Label (Green Sticker)
� Sharps and garbage bin nearby
� All on standardised trolley in treatment rooms
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•Cannulation Pack
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Practice
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Blood Safe PIVC
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Blood Safe PIVC
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Need Guidance and
Assistance
� Seek assistance if unable to insert after 2 attempts (new attempt should be proximal to original attempt)
� Note: Each attempt requires a new cannula
� Ultrasound machine available in B6c medication room
� All Cannula bacteraemia will be rated SAC 2 (Severity Assessment Code 2)
� Senior Management notification. Detailed investigation required to determine specific cause and improve practice.
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A/H PIVC Team
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U/S Guided PIVC• Difficult Intravenous Vascular Access
(DIVA) with 1 or more attempts
• Alerts:• Non visible/palpable veins
• Patient says “people always have trouble finding my veins”
• Patients who want a PICC, nobody “wants” a PICC
• Treatment less than 6 days, if longer, insert a midline or PICC
• U/S allows for more appropriate vessel choice
• Decreases risks of vascular depletion and improves outcomes
Completion
� Place insertion label on cannulation site dressing
� Electronic record entry
� Make sure patient is comfortable with buzzer in reach
� If medications or fluids due, advise RN that cannula is
inserted
If you following these practice guidelines
patients in your care will be SAFE
Post-insertion care
� Review of insertion site as part of routine clinical review
� Cannula change to occur as clinically indicated or
should not be left in for more than 72 hrs
Surveillance and re-site vital to prevent
complications or identify complications early
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First Aid� Skin: wash the exposed site
with soap and water
� Eyes: rinse thoroughly while eyes are open with water/normal saline
� Mouth: spit out and rinse with water several times
� Clothing: remove, shower if necessary
Then….� Inform your manager/supervisor
� Complete an incident on IIMS
� Contact the person at your facility responsible for Occupational Exposure management:
During Normal Business Hours (0730-1600hrs)
� Westmead Staff Health Clinics
56777
Level 1, University Clinics
After hours:
� Present to ED
Venepuncture and Specimens� E-ordering for most
pathology tests, but not all.
� Label must have Emp No and Date/Time
� Blood Bank Specimens
� Equipment
� Order of Draw
� Sending test
� A/VBG’s
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Blood Cultures
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Policies and Procedures
Resources
•HETI