Vascular access
- MC areas
brachial vein
basilica vein
cephalic vein
Vascular access
- Mc side to start on
right
Vascular access
- never use inserted line until what
- confirm in the correct place
- sign of incorrect placement: resistance with first flush
Vascular access
- 3 types of venous peripheral approach catheters
- Peripheral IV
- PICC
- Midline
Vascular access
- Peripheral IV
- Peripheral insertion
- Local access
- Initial and include date and time of placement
Vascular access
- PICC line
- Peripheral insertion
- Central access (atriocaval junction is goal endpoint)
- 1-view chest xray to confirm
Vascular access
- Midline
- Peripheral insertion
* Proximal access (don’t pass axillary vein)
Vascular access
- 4 Venous central approach catheters
- Internal Jugular
- Subclavian
- Femoral
- Tunneled hickman/broviac
Vascular access
- Internal Jugular confirmation
1 view chest XR
Vascular access
- Femoral confirmation
Abd/KUB XR
Vascular access
- what used for
- Used for long term situations, usually IJ or subclavian access
- Tunneling helps prevent infection
Vascular access on babies
- Umbilical cord: 2 arteries, 1 vein
- Use babygram/abd/KUB xray
- Venous catheter: IVC – diaphragm
- Should insert and go north, if turns 90 degrees, have gone the wrong way and prob in ductus venosus
- Arterial catheter: T6-T9 vertebral body
- Will go way down before up
- Venous and arterial access via umbilicus end in IVC
Why use a port
- For long term meds
- If not flushing, check for fibrin sheath
- Catheter can fracture, hub can turn
Why use arterial lines
- Blood gases, good option if need routine ABGs
- Peripheral insertion, local access
Swan-ganz catheter
- Measure left arterial pressure
- Central catheter: pulmonary artery is the target
Large bore dialysis catheters
- Temporary (vs. tunneled)
- Access only by dialysis nurse or otherwise special trained
- Central catheter – target is proximal right atrium
- Can be placed femoral as well
Complications of vascular access
- Malposition
- Pneumothorax
- Vascular dissection/hematoma
- Air/catheter/wire embolism
- Arrhythmia
Infection
Indications for enteric tubes
- feeding/med
- suction/drainage
- contrast
