intravenous techniques 1.to understand the proper indications for central intravenous access 2.to...

INTRAVENOUS TECHNIQUES

1. To understand the proper indications for central intravenous access

2. To know how to perform central intravenous techniques during CPR

Objectives

INDICATIONS FOR IV THERAPY

• Administer drugs and fluids

• Obtain venous blood

• Insert catheters into central circulation

ESTABLISH IV LIFELINE

• Routine part of advanced life support

• As early as possible

TYPES OF IV CANNULAS

• Hollow needles

• Indwelling plastic catheters inserted over hollow needle

• Indwelling plastic catheters inserted through a hollow needle or over a guide wire

TYPES OF IV TECHNIQUESCatheter-Over-The-Needle-Technique

TYPES OF IV TECHNIQUESCatheter-Through-The-Needle-Technique

TYPES OF IV TECHNIQUESSeldinger Technique with Guidewire

IV THERAPY

• Plastic catheter

• 14- and 16-gauge in adult

• Length depends on site

Selection of Catheters

IV THERAPY

• IV preferable to intracardiac

• Use of peripheral or femoral vein does not interrupt CPR

• Aseptic technique if possible

• Femoral must have long cannula to thoracic cavity

General Principles

IV THERAPY

• IV tubing with injection sites

• 500 mL N/S

• Plastic bottle or bag

• Keep open at 10 mL/hour

General Principles (cont.)

IV THERAPY

• Hematoma

• Cellulitis

• Thrombosis

• Phlebitis

Complications

Local

IV THERAPY

• Sepsis

• Pulmonary thromboembolism

• Catheter fragment embolism

• Air embolism

Complications (cont.)

Systemic

PERIPHERAL VENIPUNCTURE

• Effective route for drugs during CPR

• Does not interrupt CPR

• Easy technique

Advantages

PERIPHERAL VENIPUNCTURE

• In circulatory collapse, vein may be absent

• Access to central circulation may be difficult

• Isotonic solutions only

• Phlebitis common with saphenous vein

Disadvantages

FEMORAL VEIN

• Does not interrupt CPR

• Vein does not collapse

• Easy access to central circulation

Advantages

FEMORAL VEIN

• If pulse absent. Vein is hard to locate

• Long delivery time of drug into central circulation unless long catheter advanced into thoracic cavity

Disadvantages

FEMORAL VEIN

• Thrombosis or phlebitis may extend to deep or illiac veins or vena cava

• Arterial cannulation – loss of limb

• Hematoma

Complications

INTERNAL JUGULAR AND SUBCLAVIAN VENIPUNCTURE

• Access to central circulation

• Emergency access to venous circulation

Specific indications

INTERNAL JUGULAR AND SUBCLAVIAN VENIPUNCTURE

• Needle, 6 cm long

• 16-gauge catheter, 15-20 cm long

• Depth of placement from surface markers

General principles

INTERNAL JUGULAR AND SUBCLAVIAN VENIPUNCTURE

• Patient supine, 15-degree angle, head down

• Occlude needle to prevent air entry

• Never pull catheter back through needle

• Use of guidewire eliminates hazard

• Affix catheter with suture

General principles (cont.)

INTERNAL JUGULAR VENIPUNCTURE

• Dome of pleura is lower

• Straight line to right atrium

• Thoracic duct not in the way

Right Side of Neck Preferred

INTERNAL JUGULAR OVER SUBCLAVIAN

• Less risk of pleural puncture

• Hematomas in neck are visible

• Easier during CPR

Advantages

SUBCLAVIAN OVER INTERNAL JUGULAR

• More subsequent neck movement possible with prolonged cannulation

Advantages

INTERNAL JUGULAR AND SUBCLAVIAN VENIPUNCTURE

• Adjacent structures easily damaged

• More training required

• May interrupt CPR

• High complication rate

• Higher complications with thrombolytic therapy

Disadvantages

INTERNAL JUGULAR AND SUBCLAVIAN VENIPUNCTURE

• Hematoma may compromise airway

• Damage to adjacent artery, nerve, or lymphatic duct

• Perforation of endotracheal cuff

Specific local complications

INTERNAL JUGULAR AND SUBCLAVIAN VENIPUNCTURE

• Pneumothorax – Need follow-up chest x-ray

• Hemothorax

• Air embolism

• Infiltration into mediastinum or pleural space

• Arrhythmia from catheter tip

Specific systemic complications

SUBCLAVIAN CANNULATION VIA EXTERNAL JUGULAR VEIN

• Easy to learn to perform

• Peripheral venipuncture

Advantages

SUBCLAVIAN CANNULATION VIA EXTERNAL JUGULAR VEIN

• Practice required to use guide wire

• Wire or catheter may perforate veins

• May interrupt CPR

Disadvantages