VEnous Access
Aseptic v Sterile v Surgical
Warm and place target location 15 deg down (inc head)
Tourniquet (assistant to hold prox for scalp, finger for JV)
Gown Glove
Shave and Prep
Catheter
Blunt needle and syringe
Blood tubes
Hub extension and flush
Tape and window dressing
Tape and board/cap
Risks
CVC removal
IO
- PIVC
- Limb (dorsum, cephalic, cubital, basilic, dorsum, saphenous) - topical anaesthesia
- Scalp (frontal superficial, temporal post, auricular, supraorbital, post facial)
- External Jug
- Venous cut down
- Umbilical (?Periph or central)
- PICC
- CIVC (tunnelled = ↑stability ↓infection, Vascath = inlet and outlet for dialysis)
- Femoral
- SCV
- EJV (access where crosses over SCM)
- IJV
- Port
- Arterial
- IO
Warm and place target location 15 deg down (inc head)
Tourniquet (assistant to hold prox for scalp, finger for JV)
Gown Glove
Shave and Prep
Catheter
Blunt needle and syringe
Blood tubes
Hub extension and flush
Tape and window dressing
Tape and board/cap
Risks
- Thrombophlebitis
CVC removal
- Aseptic
- head slightly down (increases pressure in diastole to above atmospheric to prevent air aspiration)
- Airtight dressing for 24 hours
- Supine at 0 (or 30deg if not tolerated) for 1 hour
- Inspect tip
- Set of jobs post and prior to sitting up, then routine
IO
- Adenosine not effective due to time to heart
- Some institutions don't allow use in gas machine / POC testing as damages machine
- see Life in Fast Lane article