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Role of access

Role of access. Why? Appreciate the requirements of the user increasing efficacy of selling Essential characteristics Material Length French Position. Role of access. Revise blood pathway and significance of blood flow rates Translate flow rates to access product

emily-decker
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Role of access

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  1. Role of access • Why? • Appreciate the requirements of the user increasing efficacy of selling • Essential characteristics • Material • Length • French • Position

  2. Role of access • Revise blood pathway and significance of blood flow rates • Translate flow rates to access product • Understand requirements to use • Video • CD

  3. Selection criteria • Resistance to outflow • Negative pressure required to generate a specific flow • Larger size, less resistance to flow • Dependent upon • Length • Size • Design

  4. Design • Double lumen • 360° A&V sideholes for high flow catheter • co-axial • D- lumen • Split • Side holes • ↑risk sucking against vessel wall • Risk becomes greater as blood flows ↑

  5. Characteristics Materials Urethanes - Polyurethane - Tecothane - Tecoflex - Carbothane *Silicone

  6. Length • Length • Too short, only low flows possible • Too long - ↑resistance to flow

  7. Size • Dependent upon resistance to flow

  8. Possible insertion sites* *Medcomp training manual 1999

  9. Possible insertion sites* *Medcomp training manual 1999

  10. Site • Clinician skill/preference • Patient anatomy/condition • Coagulation status • Other CVC punctures • Intra-abdominal / thoracic pressures

  11. Insertion sites • Subclavian • Femoral • Jugular *Medcomp training manual 1999

  12. Proper tip placementRight internal jugular* At the junction of the superior vena cava and the right atrium *Medcomp training manual 1999

  13. Proper tip placement* Left subclavian vein Right femoral vein *Medcomp training manual 1999

  14. Seldinger insertion technique* *Medcomp training manual 1999

  15. Seldinger insertion technique* *Medcomp training manual 1999

  16. Seldinger insertion technique* *Medcomp training manual 1999

  17. Position • ICU scenario • PAC • Coagulopathy • Flat • Femoral access common • 2-3cms below & 1cm medial • Positioning may be difficult owing to femoral artery • Impractical if pt mobile

  18. Position • Subclavian • Commonly inadequate • Catheter curves under clavical • Hits SVC – vein collapses • Position changes affects filling pressures • RJ • Preferable • Soft tip • Length to reach RA

  19. Short term – infection rare Standard dressing for CV access Malfunction Flush Assess resistance High: clotting, positional Switch limbs - ↑recirculation risk SITE CARE* *Medcomp training manual 1999

  20. Potential patient related complications1* • Air embolism • Bacteremia • Cardiac arrhythmia • Cardiac tamponade • Central Venous Thrombus • Endocarditis *Medcomp training manual 1999

  21. Potential patient related complications2 * • Exit site infections • Hematoma • Haemorrage • Haemothorax • Vessel laceration • Pericardial rub • Pneumothorax • Retroperitoneal bleed *Medcomp training manual 1999

  22. Potential patient related complications* • Right arterial puncture • Septicemia • SVC puncture • Tunnel infection • Vessel puncture *Medcomp training manual 1999

  23. Catheter related complications* • General catheter related problems • Specific catheter related problems • Silicone • Removal of catheter • Miscellaneous *Medcomp training manual 1999

  24. Catheter related complications* *Medcomp training manual 1999

  25. Catheter occlusions/obstructions* • Mechanical obstructions • Thrombotic obstructions *Medcomp training manual 1999

  26. Intraluminal obstruction Catheter occlusions/obstructions* *Medcomp training manual 1999

  27. Fibrin Sleeve Catheter occlusions/obstructions* *Medcomp training manual 1999

  28. Fibrin Tail Catheter occlusions/obstructions* *Medcomp training manual 1999

  29. Venous Thrombosis Catheter occlusions/obstructions* *Medcomp training manual 1999

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