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Vascular Access

Vascular Access. Emergency Conference Vietnam 2014. Devices. Peripheral Sites. Veins of the Hand 1. Digital Dorsal veins 2. Dorsal Metacarpal veins 3. Dorsal venous network 4. Cephalic vein 5. Basilic vein. Peripheral Sites. Veins of the Forearm

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Vascular Access

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  1. Vascular Access Emergency Conference Vietnam 2014

  2. Devices

  3. Peripheral Sites • Veins of the Hand • 1. Digital Dorsal veins2. Dorsal Metacarpal veins3. Dorsal venous network4. Cephalic vein5. Basilic vein

  4. Peripheral Sites • Veins of the Forearm • 1. Cephalic vein2. Median Cubital vein3. Accessory Cephalic vein4. Basilic vein5. Cephalic vein6. Median antebrachial vein

  5. Peripheral IV • Butterfly & angiocaths • Short catheters generally placed in forearm, hand or scalp veins • Short term therapy and unable to handle caustic chemicals (chemotherapy)

  6. Devices 2

  7. Basic Intraosseous Access

  8. IO Indications • Adult Resuscitation • Altered Level of Consciousness • Respiratory Compromise • Hemodynamic Instability • Failed peripheral IV access

  9. Contraindications • Fracture • Local Infection • Prosthesis • Recent IO in the same extremity (24 hours) • Absence of Anatomical Landmarks (Excess Tissue)

  10. Historic Complications for IO devices • Extravasation • Compartment syndrome • Dislodgement • Fracture • Failure (Device or user in origin) • Pain • Infection Precise insertion and placement of the IO device is imperative for success

  11. 3 Needle Set Lengths Length & color are the only differences between these Catheters EZ-IO PD 15 mm Needle Set 5 mm mark EZ-IO AD 25 mm Needle Set 15 gauge Catheter EZ-IO LD 45 mm Needle Set

  12. 45 mm Needle Set 5 mm mark 25 mm Needle Set 5 mm mark needle set pending FDA clearance Note that the 5 mm mark is NOT visible above the skin Adipose or muscle tissue thickness should be considered prior to IO insertion

  13. Adult – Right Proximal Humerus Adult – Right Tibia

  14. Insertion sites Proximal Tibia Proximal Humerus

  15. Proximal Humerus Proximal Humerus Proximal Tibia Proximal Tibia Distal Tibia Distal Tibia Fractures A. Multiple options Multiple concerns? B. Multiple options?

  16. Intraosseus Access

  17. What to do next? • Flush Extension Set with Normal Saline • Attach Extension Set • Pull Back on Syringe plunger to check for return • Flush with Saline • Remove and discard syringe

  18. Central Vascular Access

  19. Subclavian Anatomy • Begins as axillary vein, eventually joins the IJ to become the inominate or brachiocephalic • Anterior scalene separates the SCA from SCV • Most common is infraclavicular approach

  20. Femoral anatomy • Vein is medial to the artery • Nerve • Artery • Vein • Lymphatic • Superficial distal to inguinal ligament, then dives deep • 0.5-2cm inferior to the inguinal ligament

  21. Seldinger Technique

  22. Procedure – Median approach • Needle insertion – approximately one half the distance between the mastoid and the sternal notch • 20-30 degree needle angle • Seldinger technique – watch for dysrhythmias

  23. Posterior Approach

  24. Anterior Approach

  25. Complications • Bleeding / bruising / haematoma • Thrombo-phlebitis • Extravasation of fluids • Inflammation / Infection to site / access • Clots / occlusion • Arterial puncture • AV fistula • Pseudoaneurysm • Osteomyelitis (IO) • Pneumothorax (subclavian + IJ CVC) • Malposition

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