2014 vascular access art
TRANSCRIPT
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Pediatrics
Vascular AccessArterial Catheterization
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Objectives
•By the end of this workshop, the learner will be able to:
‐Recall at least 3 indications and 3 contraindications for arterial catheterization
‐Name at least 5 complications associated with arterial catheterization
‐Describe the anatomic landmarks used to guide arterial catheterization at specified sites of insertion
‐ Identify the potential sites for arterial catheterization
‐Choose the appropriate sized vascular catheter according to the patient’s size
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3 Simple Steps
Obtain
Prepare
Perform
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3 Simple Steps
Obtain informed consent
Prepare
Perform
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Indications
•Arterial blood sampling
‐Oxygenation
‐Ventilation
•Frequent blood sampling
•Continuous monitoring of blood pressure
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Contraindications
•Known deficiencies of collateral circulation
•Infection at site of insertion
•Trauma injury
•Coagulopathy
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Complications
•Arterial spasm
•Thrombosis
‐Mottling proximal/distal to catheter site
•Emboli
•Hemorrhage
‐Axillary sheath hematoma
•Infection
‐Low incidence
•Skin necrosis
•Fistula
•Aneurysm
•Brachial plexus injury
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3 Simple StepsObtain informed consent
Prepare for placement
Perform
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Preparation
•Proceduralist
•Patient
•Equipment
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Preparation
•Proceduralist
•Patient
•Equipment
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Proceduralist
Flickr.com
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Timeout
•Right procedure
•Right patient
•Right side
Flickr.com
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Sterile gowning
Flickr.com
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Preparation
•Proceduralist
•Patient
•Equipment
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Sites for Insertion
•Radial/Ulnar
•Axillary
•Dorsalis pedis
•Posterior tibial
•Femoral
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•Anatomy
•Surface Landmarks
•Positioning
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Radial
•Most common site
•Lies in longitudinal groove formed by FCRM and distal radius
•Check for collateral flow
•Thrombosis is common
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Dorsalis pedis
•Descends down dorsum of foot parallel & lateral to EHLT
•Check for collateral flow
‐Occlude artery
‐Blanch great toe for several seconds
‐Release pressure & observe for flushing
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Posterior tibial
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Axillary
•Large artery
•Excellent collateral flow
•Air/thrombus embolism can cause brain/hand ischemia
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Femoral
•Also large artery
•May still be palpable with marked hypotension
•Lack of collateral flow
•Air/thrombus embolism can cause foot/toe ischemia
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Patient
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Preparation
•Proceduralist
•Patient
•Equipment
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Choosing a Catheter
•2.5 F and 2.5 cm
•2.5 F and 5 cm
•3 F and 5 cm
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3 Simple StepsObtain informed consent
Prepare for placement
Perform the procedure
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Administer medications
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Sequence of Events
Inform/Consent parents
Perform a “Time Out”
Position
•Perform Procedure/Apply sterile dressing
•Confirm Placement
•Document
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Sequence of Events
Inform/Consent parents
Perform a “Time Out”
Position
Perform Procedure/Apply sterile dressing
•Confirm Placement
•Document
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•Confirm via pressure transduction and blood gas
•Tubing used for pressure monitoring should include a Luer-lock design
•Papaverine-containing heparin solution prolongs arterial catheter life
•If you cannot transduce……
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TAKE IT OUT!!!
TAKE IT OUT!
TAKE IT OUT!!
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Sequence of Events
Inform/Consent parents
Perform a “Time Out”
Position
Perform Procedure/ Apply dressing
Confirm Placement
•Document
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STATIONS
•Ultrasound/PIV/IO
•US-guided CVC
•Arterial line placement
•CVC via landmark technique
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•Practice :
‐PIV and IO placement using a task trainer
‐ the steps for prepping and draping a site prior to:
•Central venous catheterization according to TCH PICU insertion bundle
•Arterial catheterization
•Execute the proper sequence in the placement of:
‐Ultrasound-guided central venous catheters
‐Arterial catheters according to an itemized checklist
•Integrate the “landmark technique” and use of ultrasound when performing central venous catheterization as recommended by governing/certifying bodies