Vascular Access Procedures PDF

## J. Arterial Cannulation - **Advancement of a catheter or tissue dilator into an artery.** ### Causes: - Failed identification of arterial needle puncture and continuation of procedure by insertion of dilator and or the catheter. ### Prevention: - Prior to tissue dilation and catheter advanceme...

## J. Arterial Cannulation - **Advancement of a catheter or tissue dilator into an artery.** ### Causes: - Failed identification of arterial needle puncture and continuation of procedure by insertion of dilator and or the catheter. ### Prevention: - Prior to tissue dilation and catheter advancement ensure that artery has not been punctured. - Confirmation of arterial access can be done via ultrasound of needle and/or wire, pressure waveform analysis, a rising column of blood when tubing applied and held at a level higher than the insertion point. - Blood gas analysis showing arterial oxygen levels. - If arterial access cannot be ruled out by careful ultrasound and clinical assessment, then remove needle or wire and do not continue to tissue dilation. ### Symptoms: - Bright red, pulsatile blood return or retrograde blood flow out of catheter. Note: Pulsatile blood return may not appear in cases of hypotension or placement of catheter in extremities, and blood color can be affected by blood oxygen levels and other clinical factors. - Abrupt swelling/hematoma at puncture site. - Pain, numbness, pallor, loss of pulse in affected extremity distal to puncture site. ### Treatment: - When unintended cannulation of an artery occurs with a large bore catheter (greater than 6 fr) in a central artery, the dilator or catheter should be left in place, and removal should only be done by an interventional radiologist or vascular surgeon. - Removal of small bore catheter and or dilator/sheath (6 Fr and smaller) in a compressible site can be done by the inserter immediately at the time of identification as pressure can be applied to these sites. Apply manual pressure until hemostasis is achieved. Notify the patient's licensed independent practitioner and obtain orders for appropriate site monitoring. - Focused observation is needed to ensure complications do not arise e.g. compartment syndrome. - Immediately escalate care if uncontrolled bleeding, swelling, pulses are faint or absent, pallor and/or numbness continues. ## K. Nerve Injury - **Nerves can be seen on ultrasound as nerve bundles. Nerve tissue is similar in acoustic impedance compared with other soft tissues; nerve damage can occur to major nerves in the thorax with CVAD insertion but is extremely rare and reported primarily as case reports.** - **Nerves cannot be located or identified using palpation.** ### Causes: - Nerve contact with insertion needle, guidewire, and/or catheter. - Temporary nerve irritation with prolonged positioning of arm during insertion. ### Prevention: - Use ultrasound for all VAD insertions. - Knowledge of anatomical location of nerve bundles. - Immediate removal of the needle, introducer, or catheter if patient reports shooting pain, numbness, burning, or tingling during insertion. - Identify median nerve if brachial vein is to be accessed. ### Symptoms: - Report of sudden electrical shock-like pain, numbness, burning or tingling which may radiate in non-responsive patients, extremity may jerk or twitch. - Transection of major nerve bundles can lead to persistent and debilitating symptoms of pain, numbness, weakness, tingling, and possibly paralysis. ### Treatment: - Recognition of nerve irritation and prompt removal of device. - Document symptoms, actions taken, notification of LIP, and follow up if any. ## L. Infiltration and Extravasation - **Infiltration is the inadvertent administration of medication of fluid into the tissue. Extravasation is the inadvertent administration of vesicant or large volume of solution into the tissue; either can occur with PIVs or CVADs.**