Podcast
Questions and Answers
What is the first step in the pre-procedure of cannulation?
What is the first step in the pre-procedure of cannulation?
- Assess patient’s level of consciousness and anxiety
- Provide privacy
- Greet and explain procedures to patient
- Check for doctor’s order (correct)
What is a potential complication of IV therapy?
What is a potential complication of IV therapy?
- Allergic reaction
- Anaphylaxis
- Infection
- Hematoma (correct)
What is a characteristic of the vein selected for cannulation?
What is a characteristic of the vein selected for cannulation?
- Deep in the skin
- Small and fragile
- Big enough, straight, soft and visible through the skin (correct)
- Broken or damaged
What is the threshold for PaO2 that indicates a drop in oxygen saturation?
What is the threshold for PaO2 that indicates a drop in oxygen saturation?
What should be done with disposable items and sharps after the procedure?
What should be done with disposable items and sharps after the procedure?
Why may patients receiving anticoagulant therapy be more prone to hematoma?
Why may patients receiving anticoagulant therapy be more prone to hematoma?
Which of the following is NOT a cause of decreased oxygen in the bloodstream?
Which of the following is NOT a cause of decreased oxygen in the bloodstream?
What is ecchymosis?
What is ecchymosis?
What is a possible clinical manifestation of decreased oxygen in the bloodstream?
What is a possible clinical manifestation of decreased oxygen in the bloodstream?
What should be done after washing hands during the procedure?
What should be done after washing hands during the procedure?
Which of the following can increase the risk of aspiration?
Which of the following can increase the risk of aspiration?
What is the threshold for SpO2 by pulse oximeter that indicates a drop in oxygen saturation?
What is the threshold for SpO2 by pulse oximeter that indicates a drop in oxygen saturation?
When is hematoma more likely to occur?
When is hematoma more likely to occur?
Which of the following is a possible cause of decreased oxygen consumption?
Which of the following is a possible cause of decreased oxygen consumption?
What is another term for decreased oxygen in the bloodstream?
What is another term for decreased oxygen in the bloodstream?
Which of the following conditions can delay gastric emptying?
Which of the following conditions can delay gastric emptying?
What was the occupation of Dr. John Riggs?
What was the occupation of Dr. John Riggs?
What was Horace Wells trying to achieve in his experiment?
What was Horace Wells trying to achieve in his experiment?
What is the term for the type of sedation where an inhaled drug is used?
What is the term for the type of sedation where an inhaled drug is used?
What is the advantage of inhalation sedation over oral, rectal, or intramuscular sedation?
What is the advantage of inhalation sedation over oral, rectal, or intramuscular sedation?
What is the main advantage of IV drug administration?
What is the main advantage of IV drug administration?
What is the risk of overly deepening the penetration of the needle?
What is the risk of overly deepening the penetration of the needle?
Who administered nitrous oxide to Horace Wells?
Who administered nitrous oxide to Horace Wells?
What was the effect of nitrous oxide on Horace Wells during the procedure?
What was the effect of nitrous oxide on Horace Wells during the procedure?
What is the primary concern when injecting in the upper outer quadrant of the gluteal region?
What is the primary concern when injecting in the upper outer quadrant of the gluteal region?
Why is the ventrogluteal region preferred for IM injections in certain patients?
Why is the ventrogluteal region preferred for IM injections in certain patients?
What is the advantage of submucosal sedation over IM administration?
What is the advantage of submucosal sedation over IM administration?
In which region is the submucosal sedation technique used?
In which region is the submucosal sedation technique used?
Why is the gluteal region injection method avoided by pediatric doctors?
Why is the gluteal region injection method avoided by pediatric doctors?
What are the three bony landmarks used to locate the ventrogluteal region?
What are the three bony landmarks used to locate the ventrogluteal region?
What is the disadvantage of using the gluteal region for injection?
What is the disadvantage of using the gluteal region for injection?
What type of drug is used in submucosal sedation?
What type of drug is used in submucosal sedation?
What is the primary goal of modifying the patient's state of mind with inhalation sedation?
What is the primary goal of modifying the patient's state of mind with inhalation sedation?
What is the advantage of using N2O in inhalation sedation?
What is the advantage of using N2O in inhalation sedation?
What is the equivalent analgesic effect of a 20% concentration of N20?
What is the equivalent analgesic effect of a 20% concentration of N20?
What is the recovery time from inhalation sedation with N2O-O2?
What is the recovery time from inhalation sedation with N2O-O2?
What is the effect of N2O on the liver, kidneys, brain, and cardiovascular and respiratory systems?
What is the effect of N2O on the liver, kidneys, brain, and cardiovascular and respiratory systems?
At what concentration of N20 does it produce analgesia?
At what concentration of N20 does it produce analgesia?
What is the advantage of using inhalation sedation with N2O-O2 in certain procedures?
What is the advantage of using inhalation sedation with N2O-O2 in certain procedures?
What is the significance of the margin of safety in inhalation sedation?
What is the significance of the margin of safety in inhalation sedation?
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Study Notes
Pre-Procedures
- Check doctor's order and greet patient
- Assess patient's level of consciousness and anxiety
- Provide privacy
- Wash hands
During Cannulation
- Wash hands
- Select the site and vein:
- No wound or rashes
- Vein is big enough, straight, soft, and visible through the skin
Complications of Intravenous Therapy
Hematoma
- Resulting from infiltration of blood into tissues at the venipuncture site
- Related to venipuncture technique
- Use of large bore cannula: Trauma to the vein during insertion
- Patients receiving anticoagulant therapy and long-term steroids
Hypoxia
- Present when PaO2 is less than 60 mmHg or SpO2 by pulse oximeter is less than 90%
- Causes:
- Hypoventilation
- Low inspired oxygen
- Increased oxygen consumption (e.g., shivering, sepsis, pain)
- Low cardiac output
- Anatomic shunt: refractory to oxygen therapy
- Clinical conditions that may delay gastric emptying and increase risk of aspiration:
- Anxiety
- Autonomic dysfunction (gastroparesis)
- Hiatal hernia / GERD
- Morbid obesity
- Pregnancy
- Bowel obstruction
- Head trauma / increased intracranial pressure
- Multi-trauma
IM Injections
- Deltoid muscle injection technique:
- Injection given between upper and lower portions of the deltoid muscle
- Ventrogluteal Region:
- Lies in close proximity to the gluteal region
- Primary use is for IM injection in patients who are bedridden and unable to lie face down
- Sciatic nerve:
- One of the longest nerves in the body
- Risk of paralysis if hit during injection
Submucosal Sedation
- Used in pediatric dentistry
- CNS-depressant drug is injected into the mucous membrane in either the maxillary or mandibular buccal fold
- Advantage over IM administration: slightly more rapid onset of clinical action
Inhalation Sedation
- Form of conscious sedation
- Inhaled drug:
- Depresses the central nervous system (CNS) to an extent that allows operative treatment with minimal physiological and psychological stress
- Modifies the patient's state of mind such that communication is maintained and the patient can respond to verbal command
- Carries a margin of safety wide enough to render the unintended loss of consciousness and loss of protective reflexes unlikely
- Advantages:
- Onset of action is more rapid than oral, rectal, intranasal (IN), or intramuscular (IM) sedation
- Peak clinical action in a time span permitting titration
- Recovery time is rapid
- No adverse effects on liver, kidneys, brain, or cardiovascular and respiratory systems
- N2O-O2 can be used instead of local anesthesia in certain procedures
- Analgesia produced by a 20% concentration of N20 is equivalent to that of 10 to 15 mg of morphine
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