Role of access
-
Upload
emily-decker -
Category
Documents
-
view
39 -
download
1
description
Transcript of Role of access
![Page 1: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/1.jpg)
![Page 2: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/2.jpg)
1.1. Role of accessRole of access
• Why?– Appreciate the requirements of the
user increasing efficacy of selling• Essential characteristics
– Material– Length– French– Position
![Page 3: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/3.jpg)
Role of accessRole of access
1. Revise blood pathway and significance of blood flow rates
2. Translate flow rates to access product
3. Understand requirements to use1. Video2. CD
![Page 4: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/4.jpg)
Selection criteriaSelection criteria• Resistance to outflow
– Negative pressure required to generate a specific flow
– Larger size, less resistance to flow– Dependent upon
• Length• Size• Design
![Page 5: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/5.jpg)
DesignDesign• Double lumen
– 360° A&V side holes for high flow catheter – co-axial– D- lumen– Split
• Side holes– ↑risk sucking against vessel wall– Risk becomes greater as blood flows ↑
![Page 6: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/6.jpg)
CharacteristicsCharacteristics
Materials•Urethanes - Polyurethane
- Tecothane- Tecoflex- Carbothane
*Silicone
![Page 7: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/7.jpg)
LengthLength
• Length– Too short, only low flows possible– Too long - ↑resistance to flow
![Page 8: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/8.jpg)
SizeSize
• Dependent upon resistance to flow
![Page 9: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/9.jpg)
Possible insertion Possible insertion sites*sites*
*Medcomp training manual 1999
![Page 10: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/10.jpg)
Possible insertion Possible insertion sites*sites*
Technical difficulty
Pt.comfort& mobility
Compl. risk
R. Subclavian Low Medium High R. Int. Jugul. Low High Low L. Int. Jugul. High High Medium L. Subclavian Medium Medium High R. Femoral Low Low Low R. Femoral Low Low Low
*Medcomp training manual 1999
![Page 11: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/11.jpg)
SiteSite
• Clinician skill/preference• Patient anatomy/condition• Coagulation status• Other CVC punctures• Intra-abdominal / thoracic
pressures
![Page 12: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/12.jpg)
Insertion sitesInsertion sites
*Medcomp training manual 1999
•Subclavian
•Femoral
•Jugular
![Page 13: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/13.jpg)
Proper tip placementProper tip placementRight internal jugular*Right internal jugular*
At the junction of the superior vena cava and the right atrium
*Medcomp training manual 1999
![Page 14: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/14.jpg)
Proper tip placement*Proper tip placement*
Left subclavian vein Right femoral vein
*Medcomp training manual 1999
![Page 15: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/15.jpg)
Seldinger insertion Seldinger insertion technique*technique*
*Medcomp training manual 1999
![Page 16: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/16.jpg)
Seldinger insertion Seldinger insertion technique*technique*
*Medcomp training manual 1999
![Page 17: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/17.jpg)
Seldinger insertion Seldinger insertion technique*technique*
*Medcomp training manual 1999
![Page 18: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/18.jpg)
PositionPosition
• ICU scenario– PAC– Coagulopathy– FlatFemoral access common
• 2-3cms below & 1cm medial• Positioning may be difficult owing to femoral
artery• Impractical if pt mobile
![Page 19: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/19.jpg)
PositionPosition
• Subclavian• Commonly inadequate• Catheter curves under clavical• Hits SVC – vein collapses • Position changes affects filling pressures
• RJ• Preferable• Soft tip• Length to reach RA
![Page 20: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/20.jpg)
SITE CARE*SITE CARE*
*Medcomp training manual 1999
• Short term – infection rare– Standard dressing for CV access
• Malfunction– Flush– Assess resistance
• High: clotting, positional• Switch limbs - ↑recirculation risk
![Page 21: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/21.jpg)
Potential patient related Potential patient related complicationscomplications 11**
• Air embolism• Bacteremia• Cardiac arrhythmia• Cardiac tamponade• Central Venous Thrombus• Endocarditis
*Medcomp training manual 1999
![Page 22: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/22.jpg)
Potential patient related Potential patient related ccomplicationsomplications 2 2 **
• Exit site infections• Hematoma• Haemorrage• Haemothorax• Vessel laceration• Pericardial rub• Pneumothorax• Retroperitoneal bleed
*Medcomp training manual 1999
![Page 23: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/23.jpg)
Potential patient related Potential patient related complications*complications*
• Right arterial puncture• Septicemia• SVC puncture• Tunnel infection• Vessel puncture
*Medcomp training manual 1999
![Page 24: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/24.jpg)
Catheter related Catheter related complications*complications*
1. General catheter related problems2. Specific catheter related problems
– Silicone– Removal of catheter– Miscellaneous
*Medcomp training manual 1999
![Page 25: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/25.jpg)
Catheter related Catheter related complications*complications*Symptoms Possible Causes Suggestions
Catheter can be flushed butnot aspirated
One way obstruction,possible fibrin sheathsformation. Catheter may beup against the wall of thevessel.
Reposition patient, havepatient cough, reverse thebloodlines during treatment.
Diminished flows Kink in blood lines, catheterclot
Check all bloodlines, flushwith saline. Repositionpatient and/or catheter.Reverse blood lines
High arterial pressure Kink in catheter, clot formingin filter or line behind filter.
Check for kinks, flushcatheter, check the filter.
High venous pressures Kink in catheter, clot formingat the tip of the catheter, clotin venous bubble trap.
Check for kinks, flushcatheter, check thebloodlines.
Inability to either flush oraspirete
Thrombus formation Urokinase as per physician’sorder.
*Medcomp training manual 1999
![Page 26: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/26.jpg)
Catheter Catheter
occlusions/obstructionsocclusions/obstructions**
• Mechanical obstructions• Thrombotic obstructions
*Medcomp training manual 1999
![Page 27: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/27.jpg)
Catheter Catheter
occlusions/obstructionsocclusions/obstructions**Intraluminal obstruction
*Medcomp training manual 1999
![Page 28: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/28.jpg)
Catheter Catheter occlusions/obstructions*occlusions/obstructions*
Fibrin Sleeve
*Medcomp training manual 1999
![Page 29: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/29.jpg)
Catheter Catheter occlusions/obstructions*occlusions/obstructions*
Fibrin Tail
*Medcomp training manual 1999
![Page 30: Role of access](https://reader034.fdocuments.in/reader034/viewer/2022050805/56813841550346895d9fed4a/html5/thumbnails/30.jpg)
Catheter Catheter occlusions/obstructions*occlusions/obstructions*
Venous Thrombosis
*Medcomp training manual 1999