Emergent Vascular Access: A Guide for Healthcare Professionals

Description

Preface Contents Contributors Abbreviations 1: What Is Emergent Vascular Access? Introduction Reference 2: The Physiology and Physics of Vascular Access Introduction Anatomy of the Cardiovascular System The Arterial System The Venous System Cardiovascular Physiology Other Physiological Considerations The Physics of Flow Vascular Access Devices Conclusion References 3: Landmark-Based Peripheral Intravenous Catheters Introduction Peripheral Intravenous Catheter Design Technique for Landmark-Based PIV Placement Common Peripheral Vein Targets The Antecubital (AC) Fossa The Upper Arm The Forearm The Hand and Wrist The External Jugular Vein The Lower Extremity Special Considerations for PIV Insertion Breast Cancer Hemodialysis Contractures Deep Vein Thrombosis Traumatic Injury Scar Tissue Soft Tissue Edema Phlebotomy and Order of Blood Draw Conclusions References 4: Ultrasound-Guided Peripheral Intravenous Catheters Introduction Indications for US-PIV Insertion Contraindications and Complications The Ideal Vein for US-PIV Cannulation Common Target Veins for US-PIV Cannulation The Forearm The Upper Arm The External Jugular Vein Equipment Technique Positioning Common Pitfalls Conclusions References 5: Landmark-Based Central Venous Catheters The History of Central Venous Cannulation Anatomy of the Central Veins Indications/Contraindications Indications Contraindications Types of Central Venous Catheters Supplies Needed Internal Jugular (IJ) Vein Cannulation Advantages Disadvantages Patient Positioning Insertion Site Identification Identifying the Jugular Vein The “Three-Finger Method” Needle Direction Site-Specific Risks/Complications Axillary (AX) Vein Cannulation Advantages Disadvantages Patient Positioning Insertion Site Identification Needle Direction Site-Specific Risks/Complications Subclavian (SC) Vein Cannulation: Supraclavicular Approach Advantages Disadvantages Patient Positioning Insertion Site Identification Needle Direction Site-Specific Risks/Complications Subclavian (SC) Vein Cannulation: Infraclavicular Approach Advantages Disadvantages Patient Positioning Insertion Site Identification Needle Direction Site-Specific Risks/Complications Femoral (FEM) Vein Cannulation Advantages Disadvantages Patient Positioning Insertion Site Identification Needle Insertion Site-Specific Risks/Complications Selection of Appropriate CVC Insertion Site Complications of Central Venous Cannulation Immediate Complications (During or Immediately After Procedure) Early Complications (Days After Procedure) Delayed Complications (Weeks to Months After Procedure) General Considerations for Central Venous Access Patient Positioning Preparation Sterility Air Embolism Inability to Advance the Guidewire Inability to Remove the Guidewire Confirmation of Proper Line Placement Concern for Arterial Cannulation Securing the Catheter Depth of Insertion Angle of Bend Conclusion References 6: Ultrasound-Guided Central Venous Catheters Introduction General Considerations Introduction to Ultrasound Probe/Transducer Exam Type General Tips for Ultrasound Guidance Static Versus Dynamic Techniques Static Technique Dynamic Technique The “In-Plane” Approach The “Out-of-Plane” Approach Confirming Proper Placement Needle Versus Angiocatheter Site-Specific Considerations Internal Jugular (IJ) Vein Subclavian (SC) Vein Infraclavicular Approach Supraclavicular Approach Femoral (FEM) Vein Pitfalls Complications Mechanical Complications Infectious Complications Documentation References 7: Intraosseous Catheters History of Intraosseous Access Physiology of Intraosseous Access Indications for Intraosseous Access Contraindications for Intraosseous Access Common Intraosseous Insertion Sites Sternum (Manubrium) Clavicle Proximal Humerus Distal Radius Iliac Crest Distal Femur Proximal Tibia Distal Tibia Calcaneus Complications of Intraosseous Cannulation Immediate Complications Delayed Complications Medications Flow Rates Time Required for Placement Manual Intraosseous Devices Semiautomatic Intraosseous Devices Confirmation of Proper Placement Conclusion References 8: Special Populations: Pediatrics Introduction Pediatric Vascular Access Devices Intraosseous (IO) Catheter Landmark-Based Peripheral Intravenous (PIV) Catheter Ultrasound-Guided Peripheral Intravenous (US-PIV) Catheter Central Venous Catheter (CVC) Peripherally Inserted Central Catheter (PICC) Umbilical Vein/Artery Catheterization (UVC/UAC) Arterial Catheters Methods to Enhance Placement Success Decision-Making for Pediatric Subjects Conclusions References 9: Special Populations: Cardiac Arrest Introduction Pathophysiology of Cardiac Arrest Medications in Cardiac Arrest Epinephrine (Adrenaline) Vasopressin Amiodarone Lidocaine Magnesium Sulfate Sodium Bicarbonate Location Matters Selection of Vascular Access Device Speed of Access First-Attempt Success Rates Future Directions for OHCA Research An Algorithmic Approach to VAD Placement for OHCA Conclusions References 10: Difficult Vascular Access Introduction Definition of DVA Risk Factors for Difficult Vascular Access Patient-Specific Causes of DVA Vein Visibility Venous Cutdown Vein Palpability Solutions to Enhance Vein Palpability Topical Treatments Tourniquets Alternative Site Infusion Anatomic Variation of Veins Hazardous Anatomic Structures Vessel Size Skin Characteristics Patient Compliance Provider Causes of DVA Distractibility Fatigue High-Pressure Situations Experience and Bias Environment Causes of DVA Additional DVA Risk Factors Comorbid Conditions Vascular Trauma and Vein Disease Coagulopathies History of Chemotherapy The Effects of Aging Pathways for DVA Management Conclusions References 11: Decision-Making for Emergent Vascular Access Introduction Have a Game Plan Environmental Limitations Patient Assessment Presenting Medical Conditions Medication Characteristics Provider-Specific Considerations Device Limitations Guidelines and Policies Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) [12] Infusion Nurses Society (INS) Infusion Therapy Standards of Practice Vessel Health and Preservation: The Right Approach for Vascular Access Rapid Assessment of the Central Veins (RaCeVA) and Peripheral Veins (RaPeVA) Guidelines for the Prevention of Intravascular Catheter-Related Infections A Decision-Making Algorithm Conclusions References 12: The Future of Emergent Vascular Access Introduction The Future of Peripheral Intravenous Lines The Future of Central Venous Catheters Ultrasound Guidance Portable Ultrasound Devices Line Stabilization and Securement The Future of Intraosseous Catheters Subcutaneous Injection Proctoclysis Other Anatomic Sites for Venous Access Guidelines Conclusions Bibliography 13: Arterial Catheters Introduction Arterial Anatomy Arteries of the Wrist Femoral Artery Insertion Site Selection Indications for Arterial Cannulation Contraindications Complications Procedural Approaches General Procedural Preparation Seldinger Technique Modified Seldinger Technique Catheter-Over-Needle Technique Pressure Transducer Setup Interpreting Arterial Pressure Waveforms Troubleshooting the Transducer Considerations for Ultrasound Considerations for Type of Arterial Catheter Arterial Blood Sampling Conclusions References Index