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Intravenous catheterisation powerpoint presentation
- 1. Indications And InsertionOf Peripheral Intravenous Catheter Central Venous catheter Dr.KERERTHANA PRASITHA Post graduate GENERAL MEDICINE
- 2. Intravenous Cannulation • Intravenouscannulation is a technique in which a cannula is placed inside a vein to provide venous access. • Venous access allows sampling of blood as well as administration of fluids, medications, parenteral nutrition, chemotherapy and blood products.
- 3. CANNULA This device isavailable in various gauges (14-24 G),lengths (25-44mm), compositions and designs.
- 6. • Routinely, usethe smallest gauge of catheter, if possible to prevent damage to the vessel intima. • In an emergency situation use a large gauge catheter to allow administration of large volumes of fluid. • The superficial veins of the upper extremities are preferred to those of the lower extremities for peripheral venous access as they interfere less with patient mobility and pose a lower risk for phlebitis. • It is recommended to choose a straight portion of a vein to minimize the chance of hitting valves. • Use the patient’s non-dominant arm (if possible)
- 7. For prolonged coursesof therapy , it is recommended to start distally and move proximally as distal catheters are replaced. Indications of IV Cannula Repeated blood sampling Intravenous fluid administration Intravenous medications administration Intravenous chemotherapy administration Intravenous nutritional support Intravenous blood or blood products administration Intravenous administration of radiological contrast agents for CT,MRI or nuclear imaging
- 8. Contraindications o No absolutecontraindications to intravenous cannulations exist. o When peripheral venous access is in an injured, infected, or burned extremity, it should be avoided if possible. o Some irritant solutions can cause blistering and tissue necrosis if they leak into the tissue. e.g, chemotherapeutic agents. These solutions are more safely infused into a central vein.
- 9. Equipment Non-sterile gloves Tourniquet Antiseptic solution 5-ml syringe Sterile gauze Cannula Saline Plaster
- 10. Before the Procedure 1.Introduce yourself to the patient . Explain the procedure to the patient and gain informed consent to continue. 2.Make sure there is adequate light and that the room is warm enough to encourage Vasodilation 3.Make sure the patient in a comfortable position and place a pillow or a rolled towel under the patient’s extended arm. 4.The patient’s skin should be washed with soap and water if visible dirty.
- 11. 5.If difficulty isencountered in finding anappropriate vein , one of the following techniques may be used: - Inspection of the opposite extremity - Opening and closing the fist - Gentle tapping or stroking of the site - Applying heat (warm towel/pack) TECHNIQUE 1. Apply tourniquet and select the appropriate vein 2. Apply an antiseptic solution with friction for 30-60 seconds, allow to air dry for up. Once cleaned, do not touch or replate the skin.
- 12. 3. Remove thecannula from its packaging and remove the needle cover ensuring not to touch the needle 4. Stretch the skin distally and tell the patient to expect a sharp scratch. 5. Insert the needle, bevel upwards at about 30 degrees 6. Advance the needle until a flashback of blood is seen in the hub at the back of the cannula 7.Once this is seen, progress the entire cannula a further 2mm, then fix the needle, advancing the rest of the cannula into the vein. 8. Release the tourniquet apply pressure to the vein at the tip of the cannula and remove the needle fully
- 13. 9. Remove thecap from the needle and put this on the end of the cannula. 10. Carefully dispose of the needle into the sharps box 11.Check function by flushing with saline . If there is any resistance, if it causes any pain, or you notice any localized tissue swelling; Immediately stop flushing , remove the cannula and start again. 12. Apply the plaster to the cannula to fix it in place. 13. Finally ensure that the patient is comfortable and thank them.
- 14. Complications • Pain • Failureto access the vein • Blood stops flowing into the flashback • Chamber • Arterial puncture • Thrombophlebitis • Peripheral nerve palsy • Skin and soft tissue necrosis
- 15. CENTRAL VENOUS CATHETER(CVC) DEFINATION: A central venous catheter (CVC), also known as a central line, central venous line, or central venous access catheter, is a catheter placed into a larger vein. REGULAR SITES : Catheters can be placed in veins, • Neck (internal jugular vein), • Chest (subcalvin vein or axillary vein), • Groin (femoral vein), • Peripherally inserted central catheters. (PICC)
- 16. Medical Uses Administermedication Fluids that are unable to be taken by mouth Would harm a smaller peripheral lines Obtain blood tests Measures central venous pressure Indications: o Long- terms intravenous antibiotics, parenteral nutrition in chronically ill persons. o Long-terms pain medications & chemotherapy o Drugs that are prone to cause phlebitis in peripheral venis such as • Calcium chloride Chemotherapy • Hypertonic saline Potassium Chloride (KCI) o Frequent blood draws o Monitoring of the central venous pressure (CVP).
- 18. TUNNELED CATHETERS • Tunneled– Catheters: Preferable Sites • Neck (internal) jugular • Groin (femoral), • Liver (transhepatic), • Back (trans lumbar). The catheter is tunneled under the skin • Non-Tunneled – Catheters Preferable Sites • First Choice: right internal jugular vein • Second choice: femoral vein • Third choice: Left internal jugular vein • Last choice: Subclavian vein with preference for the dominant side.
- 19. Indications • Chemotherapy • Nutritionand • Fluids • Blood Samples • Increasing age of patients initiating hemodialysis • Increasing number of comorbid conditions including significant vascular disease • Urgent renal replacement therapy (RRT)
- 20. Contra Indications forTunneled and non-Tunneled Catheter Local cellulitis Low platelet counts Local infection Avoid in raised intracranial pressure – aim for a femoral approach if required Patient non- compliance Systemic sepsis is an absolute contraindication for central venous access via tunneled catheter because it can lead to line infection Complication: • Bleeding • Infection • Puncture of adjacent structures (such as other veins or arteries) • Air embolism (air in the veins)
- 21. • Collapse ofthe lungs (pneumothorax) • Bleeding into the chest (hemothorax) • Catheter breakage (when it is being removed) Patient education: Explain the procedure to the patient and family members. Explain the need of central line and benefits, risk and complications. Equipment required for central line (central venous catheter) insertion • Sterile trolley (cvp tray) • Sterile field, gloves, gown and mask • Central line kit • Saline flush • Chlorhexidine
- 22. • Lignocaine (4ml(2 vials) of 2% is reasonable) • Suture • Scalpel • Central line fix
- 23. Seldinger Technique: The Seldingertechnique, also known as Seldinger wire technique, is a medical procedure to obtain safe access to blood vessels and other hollow organs
- 24. Pre-procedure: • Consent patientif conscious otherwise document why the procedure is in patient’s best interests • Consent should include Infection, bleeding (arterial puncture, haematoma, hemothorax), pain, failure, • Set up sterile trolley • Position patient with head down if they can tolerate it, with head facing away from side of insertion. This ensures maximum venous filling • Having a nurse or assistance is helpful
- 25. Procedure for centralline (Central venous catheter insertion) Wash hands and wear sterile gown and gloves Clean the area and apply sterile field. Make sure to have some spare gauze swabs ready. Apply sterile sheath to the ultrasound probe Confirm anatomy Under ultrasound guidance insert lignocaine cutaneous, subcutaneously and around preferred site. Whilst lignocaine has time to work flush all lumens of the line and then clamp all lumens except the seldinger port
- 26. Ensure capsare available for the lumens Under ultrasound guidance take seldinger needle attached to syringe and insert into the internal jugular vein When blood is freely aspirated remove syringe and immediately inset seldinger wire. This should pass easily Keeping hold of the inserted wire, remove the needle. Ensure the wire stays in the vein as you do this
- 30. Use scalpel tomake a small incision in the skin (approx 3mm). This should be done cutting away from the wire so as not to damage it. Pass the dilator over the wire and gently but firmly dilate a tract through to the internal jugular. At this stage there may be some bleeding so ensure to have some swabs ready Remove the dilator and pass the central line over the Seldinger wire. Do not advance the line until you have hold of the end of the wire Once the central line is in place, remove the wire Aspirate and flush all lumens and re clamp and apply lumen caps Suture the line.
- 31. Dress witha clear dressing so the insertion point can be clearly seen Documentation: • Patient is educated about the need • Site assessed and marked • All lumens clamped • Inserted by Physician, assisted by • Tip position confirmation via fluoroscopy OR Chest X-ray • Date and time of insertion, assess the site for extra bleeding. • Anatomical location. • Catheter depth according to catheter reference
- 32. CVP monitoring Central venouspressure CVP is the blood pressure in the venae cavae, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood back into the arterial systems. • The normal range for CVP is 0 to 5 mm H2O Care of CVP LINE: Care and maintenance • Assessment – Insertion site – Catheter tract – Adjacent Skin • Site Care – Skin Disinfection – Clean, dry and occlusive dressings • Dressings Gauze or Transparent Semi- Permeable
- 33. Procedure for SiteCare and dressing Change • During Procedure 1. Remove dressing from VAD insertion site. 2. Inspect site and catheter 3. Disinfect the catheter- Skin junction using antiseptic solution 4.Dress access site • After Procedure 1. Discard used supplies 2. Remove gloves 3. Wash hands 4. Label new dressing 5. Document