Hold the needle hub (stabilize it) with your non-dominant hand while unscrewing the syringe – carefully!.You will see blood aspirate freely when you are in the lumen Do not push down with ultrasound or you will compress the vein. Insert syringe needle into vein under ultrasound guidance while maintaining negative pressure on syringe.Identify site with ultrasound and align vein in middle of ultrasound screen.Slide wire of guidewire until curved wire tip is straight.Flush your catheter with saline to know it’s patent and working, cap/clip to ensure no air enters catheter after flushing.Anesthetize insertion site with lidocaine.Identify insertion site with ultrasound. Place sterile probe cover over ultrasound probe, secure with rubber bands, and place sterile gel outside.Open kit and sterilly add equipment not in kit (flushes, biopatch, caps, etc).Put gel on probe (there has to be gel inside the probe cover and outside).Ultrasound to identify anatomy and insertion site, vein is compressible and artery is pulsatile and non-compressible.Hand-dominant IJ preferred (US-guided, compressible site, pt can walk with this site) Compromise of circulation distal to arterial line (Example: Raynaud’s, thromboangiitis obliterans).Line kit, chlorhexidine, lidocaine, face mask, cap, sterile gown, sterile gloves, 3+of saline flushes (remember the saline is sterile, but sometimes the syringe is not, not needed for arterial line), sterile caps, biopatch (blue to the sky), sterile probe cover, ultrasound Reliable titration of pressors, inotropes, and antihypertensive infusions.Continuous monitoring of blood pressure.Of note a “midline” enters in the same spot but is shorter and ends around the axillary vein.This insertion site can be kept longer than a traditional PIV and is great for patients who will require long-term infusions like antibiotics (you can administer pressors through a PICC).CVC introduced through deep vein on upper arm (eg brachial) ends at SVC.Peripherally Introduced Central Cathether (PICC) for chemotherapy or patients requiring recurrent access (like sickle cell).Hickman (tunneled catheter in subclavian) used for rapid resuscitation such as hemorrhage, or to “introduce” other equipment such as a PA-catheter or Transvenous Pacer.Introducer Sheath (large-bore, common trade name Cortis) Can also be tunneled (by surgery or IR) for semi-permanent placement (often then called a Permacath).DO NOT use on an HD for care outside of a dialysis machine without the central port.dialysis or plasmapheresis catheter, can have a central port for central access.administration of vasopressors, hypertonic saline (3%)ĭialysis Catheter (Quinton in our institutions).usually triple lumen, routine central catheter for the ICU.The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters Vascular Complications of Central Venous Catheter Placement: Evidence-Based Methods for Prevention and Treatment Neuromalignant Syndrome (NMS) and Serotonin Syndrome (SS).Cerebral Edema and Elevated Intracranial Pressure.Thrombotic Thrombocytopenia Pupura (TTP).Management of Coagulopathy in Liver Disease.Immune (or Idiopathic) Thrombocytopenia.Disseminated Intravascular Coagulation (DIC).Cardiac Arrest and Targeted Temperature Management.Pulmonary Artery Catheterization Training Video.ACGME Common Program Requirements (Fellowship) (PDF).Updates in Postcardiac Arrest Targeted Temperature Management.Sepsis & The Future of Early-Goal-Directed-Therapy.Pulmonary Hypertension & Special Implications of Right Heart Failure in the ICU.Liver Disease in Pulmonary & Critical Care Medicine.
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