Overview of vascular access Types

Techniques
Key points I. O.

Overview
The vascular access is an integral part of ACLS survey. Your initial sentence in Mega Code is OMI oxygen. monitor. i.v. access.

Overview
Why its important !! It is access to your medication during the code Access to iv fluids Sometimes to get blood sample. But you have to know the priority in the code !!!!!

Peripheral line

I.O.

Types
E.T.T.
CENTRAL

PERIPHERAL

I.O.

CVP

ETT

Peripheral line insertion

Advantages: The preferred root during Code. Avoid chest compression interruption Less complications. Compressible Can be multiple. Better flow. Similar efficacy.

Peripheral line insertion

Technique : Aseptic procedure. Choose site Choose cannula Comfort yourself. Tourniquet. Position the limb. UL>>>LL Attempt cannulation on visible vein. When use in code flush 20 ml NS elevate limb10-20 sec.

Peripheral line complications (3 main)

Phlebitis
Catheter material Catheter size Site of insertion Skill of operator Duration of cannula Type of infusion

Infection
Contaminated infusions Inadequate skin Preparation

Extravasation
Age Site of cannula Type of cannula Duration of cannula IV drug infusions

Intraosseous Access
Key points Intraosseous infusion is a temporary emergency measure. Indicated in life-threatening situations when intravenous access fails (3 attempts or >90 seconds) . Easy and even in awake it is nearly painless Use an aseptic technique . Crystalloids, colloids, blood products and drugs can be infused.

Intraossious access Technique

Aseptic Choose the site
Tibia , femur , others

Load the driver Position patella tibial tuberosity below and medial 90 degree your needle Fix the bone firm but gentle Drive the power and let it go easily Confirm the position

Site
sepsis Screw Trocar

Use

Intraossious access Complications

Infections such as cellulitits and osteomylitis from poor antiseptic technique or prolonged (>72 h) needle placement .

Extravasation of blood or infusion into surrounding soft tissue from poor technique or prolonged infusion compartment syndrome from extravasation.

Intraossious access Complications

Bent needle from poor technique or missed landmark. Bone fracture or through-and-through penetration from excessive force. Tissue injury vessel ,nerve .... Clogged needle

Intraosseous Access Contraindications

Infection at entry site Burn at entry site Ipsilateral fracture of the extremity . Bone disease Osteogenesis imperfecta Osteopenia Osteopetrosis Previous attempt at the same site Previous attempt in different location on same bone Previous sternotomy (sternum insertion) Unable to locate landmarks.

Femoral

I.J.V

Subclavian

Central venous access internal jugular V.

Anatomy of the IJV

The vein originates at the jugular foramen and runs down the neck, to terminate behind the sternoclavicular joint, where it joins the subclavian vein. It lies alongside the carotid artery .

Central venous access internal jugular V. Technique position + aseptic + landmark

Place the patient in a supine position, at least 15 degrees head-down to distend the neck veins and to reduce the risk of air embolism. Turn the head away from the venepuncture site. Cleanse the skin and drape the area. Sterile gloves and a gown should be worn . a) Ulterasound use. b) Landmark technique using Seldinger. Confirmation by x ray , wave form , VBG

internal jugular vein line Complications

Pneumothorax /haemothorax x-ray is mandatory even failed

trial .

Air embolism - ensure head-down position.

Arrhythmias - avoid passing guide wire too far, observe rhythm

on cardiac monitor during insertion.

Carotid artery puncture/cannulation - palpate artery and

ensure needle is lateral to it, use ultrasound-guided placement.

Chylothorax - use a high approach and avoid left side wherever

possible.

Infection .

Cannulation of the femoral vein Anatomy The femoral vein is the continuation of the popliteal vein accompanies the femoral artery in the femoral triangle. The femoral vein ends medial to the artery at the inguinal ligament, where it becomes the external iliac vein.

Cannulation of the femoral vein

Technique position+ aseptic + landmark Extend the patients leg and abduct slightly at the hip. full aseptic. Locate the femoral artery, keep a finger on the artery and introduce a needle attached to a 10 ml syringe at 45 degrees, medial to the femoral artery pulsation, 2 cm below the inguinal ligament. Slowly advance the needle directed to the umbilicus. When a free flow of blood appears, follow the Seldinger approach, as detailed previously Confirm the position.

femoral vein line Complications

Deep vein thrombosis Arterial or neurological damage Infection Arterio-venous fistula.

Cannulation of the subclavian vein

Anatomy
The SCV is the continuation of the axillary vein and originates at the lateral border of the first rib. The SCV passes over the first rib anterior to the subclavian artery, to join with the internal jugular vein at the medial end of the clavicle.

Cannulation of the subclavian vein

Technique position+ aseptic + landmark Place the patient in a supine, head-down. Turn the head to the contra-lateral side. full aseptic . Introduce a needle attached to a 10 ml syringe, 1 cm below the junction of the middle and medial thirds of the clavicle. Direct the needle medially, slightly cephalad, and posteriorly behind the clavicle toward the suprasternal notch). Slowly advance the needle. When a free flow of blood appears, follow the Seldinger approach

Confirmation

The subclavian vein line Complications

Pneumothorax/haemothorax . Air embolism - ensure head-down position. Arrhythmias - avoid passing guidewire too far, observe rhythm on cardiac monitor during insertion. Chylothorax - use a high approach and avoid left side wherever possible. Infection .

The message
Priority for High quality CPR ,Early defibrillation when indicated. Vascular access peripheral IO CVC ETT. Easiest IO Safest peripheral . ETT unpredictable blood level of drugs. (NAVEL) CVC need Expert and trained personnel.

The message
Be safe for all (universal precautions- PPE needless ports maximum barrier precautions complete aseptic technique discard sharps)