Intravenous Access Martin Helán MD, PhD 29.2.2016 —Peripheral i.v. cannula —Central venous catheter —Dialyzation catheter —Peripherally inserted central venous catheter PICC —Central venous Port —Intraosseal i.v. access What possibilities do we have? Peripheral venous access - Indication – WHY? lacute drugs lrepeated blood samples linfusion therapy (crystaloid, colloid, blood, parenteral nutrition, …) lanesthesia Peripheral venous access – WHERE? •back of the hand (wide, well filled veins) •forearm •cubital fossa •wrist •external jugular vein •head (12M) Peripheral venous access – HOW? lplace turniket luse disinfection of the skin lfix skin and vein by fingers lpunction of the vein lpull out metal needle, pull in flexible part ldisplace turniket lfixation by a plaster lnext attempt proximally Peripheral venous access – HOW? > > Complications of peripheral vein canylation During puncture laccidental puncture of brachial artery or median nerve lhematoma Late complications lthrombosis linsufficient blood filling linfection – phlebitis > Cannula diameter – Why it is important? > > Insufficient dilution of the drug HEMATOMA Infiltration / Extravazace Tromboembolie Infection lAdministration of concentrated fluid, catecholamins, chemotherapy lMeasurement of Central Venous Pressure lParenteral nutrition lDialysis and Continual elimination lTemporary cardiostimulation lUnable maintain other (peripheral) vein access Central venous catheter – Why? limpaired coagulation lthrombocytopenia ltumor nearby or infection, trauma in place of puncture lPneumothorax or lung pathology contralaterally ltroubles with placing head Central venous catheter – Contraindications lv. jugularis interna lv. subclavia lv. femoralis l(v. brachiocephalica) Central venous catheter – Where? Seldinger technique Central venous catheter - What to do after cannulation lsterile cover lcontrol chest X-ray lexclude PNO lcheck position of catheter larythmias lPNO lbleeding lpunction of arteria ldamage of plexus brachialis lair emboly lthrombosis (v.femoralis) linfection, sepsis Central venous catheter - Complications > lchildren ltuberositas tibiae ladult •tuberositas tibiae •maleolus medialis •caput humeri Intraoseal access Intraoseal access Intraoseal access – how? Manual systems B.I.G. – Bone injection gun Drill Intraoseal access Thank you for your attention Questions?