by samer al-ashqar head nurse emergency department kfsh&rc
Post on 26-Mar-2015
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By Samer Al-Ashqar
HEAD NURSEEMERGENCY Department
Kfsh&RC
A portacath is an implantable port device, which is positioned completely under the skin and inserted into the subclavian vein and avoid the need for repeated venepuncture or cannulation.
Used for patient who may require regular drug administration, often as an inpatient.
◙ Is the process of injection directly into the marrow of the bone .
◙ Alternative route when peripheral blood vessels are collapsed or inaccessible.
INDICATIONS FOR INTRAOSSEOUS ACCESS
Altered Level of Consciousness
Respiratory Compromise Need for immediate rapid sequence induction
Hemodynamic Instability Mass Casualty Situations
Medical or Trauma resuscitations
Difficult or impossible IV Placement
Bridge to Central Line Allowing for controlled central venous placement
Intraosseous Access = Immediate Vascular Access
CONTRAINDICATIONS FOR IO
Fracture
Infection at the insertion site
Prosthesis
Recent IO in same extremity (24 hours)
Absence of Anatomical Landmarks (Excessive
Tissue)
Distal Femur Proximal Tibia Distal Tibia Proximal Humerus
PEDIATRIC IO INSERTION SITES
REMOVE DRIVER FROM NEEDLE SET
Stabilize Needle Set while disconnecting DriverT-430 Rev, E
A stabilizer is available if needed
Stabilize Needle Set and rotate the stylet counter-clockwise
Remove stylet and dispose of in approved bio-hazard sharps container
T-430 Rev, E
REMOVAL OF THE STYLET
Confirm by noting one or more of the following:
Firmly seated catheter
Flash of blood in the catheter hub or blood on aspiration *
Pressurized fluids flow without difficulty
Pharmacologic effects
* may or may not be able to aspirate blood
Monitor the insertion site and posterior extremity for signs of extravasation
CONFIRM CATHETER PLACEMENT
T-430 Rev, E
in approved bio-hazard sharps containers
Portable sharps protector
45 mm Needle Set sharps protector
PUT STYLETS WHERE THEY BELONG . . .
T-430 Rev, E
A catheter that is inserted into the trachea through the mouth or nose in order to :
Maintain an open air passage
Deliver oxygen
Permit the suctioning of mucus
Prevent aspiration of the stomach contents
Right or left mainstemEsophagus
Secretions in ETTPatient biting the ETTKinks in ventilator circuitWater in ventilator circuit
Unilateral chest riseAbsence of air entry on one side of the chestTracheal deviation toward the unaffected lung
Lack of pressure in the ETT cuffConnections between the ETT / ventilator are secureThe ventilator circuit is free of defectThe ventilator is functioning normallyIncorrect ventilator settings
f. Power supply to ventilator (Red Outlet)
VAP bundle:
Sedation vacationHOB > 30 degreesOG tubeMeticulous oral careGastrointestinal prophylactic agentsDeep vein thrombosis prophylactics
Feeding tubes are increasingly used for long term enteral nutrition. It is used where patients cannot maintain adequate nutrition with oral intake
Prematurity Central nervous system problems Burns Head trauma Inherited metabolic disorders Gastrointestinal diseases Failure to thrive Abnormalities of the anatomy of the gastrointestinal tract Severe cleft lip/cleft palate Cancer
Satisfactory use by home caregiversLow incidence of complicationsReduction in aspiration pneumonia associated with swallowing disordersCost effective
Examine skin around site for infection/ irritationClean stoma site with sterile saline.Dry area with gauze.Rotate gastrostomy tube to prevent adherence to sides of trackWound care advice.
Tube blockagesTube dislodgementsExternal leakageUnplanned removal
Site infections
Tracheostomy are surgical procedures on the neck to open a direct airway through an incision in the trachea
Inner cannula—Smaller tube that fits inside the tracheostomy tube, which can be removed quickly if it becomes obstructed. This is often used for patients who have copious secretions.
Tracheostomy tube—An indwelling tube used to maintain patency of the tracheostomy. It can be made of metal (for long term use) or disposable plastic. The tube can be cuffed (a balloon is inflated to keep the tube in place) or uncuffed (air is allowed to flow freely around the tube). It can also be fenestrated, which allows the patient to speak.
1. Bleeding.2. Infection.3. Trach plugging.4. Granulation (scar) tissue.5. Skin necrosis.
1. Restlessness or increased irritability.2. Increased breathing (respiratory) rate.3. Heavy, hard breathing.4. Grunting, noisy breathing.5. Nasal flaring (sides of nostrils move in and out with breathing).
6. Retraction (sinking in of breastbone and skin between the ribs with each breath).7. Blue or pale color.8. Whistling from the trach tube.9. Sweating.10. Change in pattern of heart rate (less than 80 or more than 210 beats/minute).11. Bleeding from trach tube
Sterile Technique: sterile catheters and sterile gloves
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