SURGERY 2

 Video on How to start an IV dorsum of hand:

VASCULAR ACCESS MODULE https://www.youtube.com/watch?v=Xms43IPHbwU
Dr. Lucas | Dr. Bangaoet  Video on How to start an IV antecubital fossa:
https://www.youtube.com/watch?v=cAQ0UEdu9ZI
 Video on IV insertion technique in infants & small children:
OUTLINE https://www.youtube.com/watch?v=bu5zgfZFViY
I. Peripheral venous access
II. Central venous access VENOUS CUTDOWN
III. Arterial access  Venous cutdowns are for the purpose of having an emergency
IV. Intraosseous access venous access
 When attempts to gain access via peripheral or percutaneous routes
I. PERIPHERAL VENOUS ACCESS have failed
 Among the most common medical procedures  Video on venous cutdown:
 Allows safe infusion of: https://www.youtube.com/watch?v=AHuJZHvTNGE
o Medications
o Hydration fluids II. CENTRAL VENOUS ACCESS
o Blood products  Often preferred in patients receiving sclerosing medications that
o Nutritional supplements can damage peripheral veins or being treated with vasopressors,
which can cause injury if extravasated
PERIPHERAL VS CENTRAL  Preferable in patients with severe volume depletion or in whom
peripheral venous catheter placement has a low likelihood of success
Peripheral Central (ie, frequent users of illicit IV drugs)
o IV access for shorter periods o Patients receiving  Used to give medicines, fluids, nutrients, or blood products over a
o Direct access to central circulation sclerosing medications long period of time (several weeks or more)
unnecessary o Severe volume  Video on central venous catheterization (internal jugular vein):
o Smaller gauge catheters suffice depletion https://www.youtube.com/watch?v=4-uyTUzPSJ8
o Safer, easier, less painful  Since peripheral  Video on femoral central venous catheterization:
o Patients taking in anticoagulants veins may be https://www.youtube.com/watch?v=KW1gjL-hMhk
 are given peripherally so that collapsed
in case of bleeding it is easier III. ARTERIAL ACCESS
to control with compression INDICATIONS
 Continuous direct BP monitoring- more accurate than
INDICATIONS sphygnomanometric BP readings for those who are morbidly obese,
 Provide therapies that cannot be administered or are less effective if very thin, have extremity burns, or have very low blood pressures
given by alternative routes  Inability to use indirect BP monitoring (extreme obesity, severe
 IV hydration and nutritional support in patients with severe vomiting burns)
or abdominal pain from surgical conditions  Frequent blood sampling
 Rapid onset or increased bioavailability of certain medications if  Frequent arterial blood gas sampling
given IV  Video on arterial line placement:
 Clinical situations: cardiac arrest https://www.youtube.com/watch?v=3z9vHu4r6HE
 Blood products  Video on arterial cannula:
https://www.youtube.com/watch?v=IsfmzuOEWWk
CONTRAINDICATIONS  Video on radial arterial access technique:
 Appropriate therapy can be provided by less invasive routes (orally) https://www.youtube.com/watch?v=8rGMHShZ_-I
 Limb with significant motor/sensory deficit  Video on common femoral arterial access technique:
https://www.youtube.com/watch?v=LChKL2E95jE
DIFFICULTY
 Obesity IV. INTRAOSSEOUS CATHETER PLACEMENT
 Underweight  Indicated in any clinical situation where vascular access is
 Edema emergently needed but not immediately available via a peripheral
 Clinician experience vein
 Provides a means of administering medications, glucose, and fluids,
 Ultrasound guidance can assist IV insertion for difficult cases as well as a means of obtaining blood samples
 But if insertion is too difficult, Intraosseous and central venous  Video on intraosseous catheter placement of children:
access can be used alternatively https://www.youtube.com/watch?v=INO5K-QjiTw

PERIPHERAL VENOUS CATHETER INSERTION From OT

MATERIALS STEPS IN PERIPHERAL VENOUS CATHETER INSERTION
 Peripheral venous catheters 1. Introduce yourself, identify the patient, explain the procedure and
o Pliable plastic tubes with an inner needle obturator get consent
2. Prepare the following equipment
o Range in size from 26 (smaller) to 14 (larger)
 Connective tubing and IV fluid a. Alcohol gel
 Skin preparation b. Gloves
c. Alcohol wipe
 Dressing
 Tape d. Tourniquet (ideally disposable)
e. IV cannula
 Clean gloves and eye protection
f. Primed IV line
 Others: topical anesthetic, fluid warmers, pressure infuser, splint
g. Suitable plaster
h. Syringe

Transcribers: JULIAN Page 1 of 2

 SURGERY 2
i. Saline
j. Sharps bin
3. Sanitize your hands
4. Position arm so that it is comfortable for the patient and the vein is
accessible
5. Apply tourniquet and recheck the vein
6. Put on gloves. Clean the patient’s skin with alcohol wipe and let it
dry
7. Remove the cannula from its packaging and remove the needle
cover ensuring not to touch the needle
8. Stretch the skin distally and tell the patient to expect a sharp scratch
9. Insert the needle, bevel up at 30 degrees. Advance the needle until
a flashback of blood is seen at the hub
10. Once seen, progress the cannula 2 mm then fix the needle and
advance the rest of the cannula (no need to insert the needle any
further)
11. Release the tourniquet, apply pressure to the vein at the tip of the
cannula and remove the needle fully. Remove the cap from the
needle and put this on the end of the cannula
12. Carefully dispose the needle into the sharps box
13. Apply the dressing to the cannula to fix it in place
14. Dispose materials used
15. Connect IV line site. Refer accordingly

Transcribers: JULIAN Page 2 of 2