Vascular Access Board Certification Study Guide PDF

# Vascular Access Board Certification Study Guide ## J. Intraosseous Devices - **Indications/Contraindications** - **Indications:** - Rapid venous access in emergency situations. - **Contraindications:** - Trauma or fracture in the area of projected access. - Bone disease. - Co...

# Vascular Access Board Certification Study Guide ## J. Intraosseous Devices - **Indications/Contraindications** - **Indications:** - Rapid venous access in emergency situations. - **Contraindications:** - Trauma or fracture in the area of projected access. - Bone disease. - Compartment Syndrome. - Infection at area of insertion. - Inability to identify landmarks. - IO access, or attempted IO access in target bone within previous 48 hours. - Previous, significant orthopedic procedure at the site, prosthetic limb, or joint. - **Site Selection** - Site selection is limited to the approved sites per the device manufacturer's instructions for use. - **Common sites:** - Proximal humerus (preferred for adults). - Proximal and distal tibia (away from the growth plate in the tibia). - **Alternative sites:** - Sternum, iliac crest, or femur. - **Insertion Procedures and Supplies** - **General Considerations:** - Follow all manufacturer's instructions for use. - Implement proper site disinfection and aseptic technique prior to access. - IO's have a maximum dwell of 24 hours in the US. - Only one attempt may be made in the same bone per 48 hours (i.e., proximal and distal tibia insertion sites). - Ideally utilize a manufacturer recommended engineered stabilization device to prevent dislodgement. - Due to pain with fluid and medication administration, administer lidocaine 2% (Preservative Free and Epinephrine Free solutions) as needed to provide analgesia. - IV fluids, blood, and medications may be administered. - **Supplies:** - Intraosseous access needle device (manual, impact driven, or power drill design). - **Procedure** - **Position site:** - **Proximal Humerus:** Adduct the arm and place the patients hand across the abdomen with the arm tight to the body to rotate the biceps tendon medially which protects it from needle damage. - **Alternatively** - internal rotation of the arm will achieve a similar position to rotate the biceps tendon medially which protects it from needle damage. - **Proximal and Distal Tibia:** Extend the lower extremity into neutral alignment. - **Cleanse site.** - **Insert needle:** Clinical judgment should be used to determine appropriate needle set selection based on patient weight, anatomy, and tissue depth overlying the insertion site; refer to manufacturer's recommendations for additional considerations. - **Apply engineered stabilization device.** - **Apply primed extension set.** - **Flush device.** - **Aspirate for marrow.** - **Administer lidocaine** as needed for intermittent pain control. - **Apply NS fluids** as a running line with the aid of a pressure bag to facilitate infusion rate and medication administration. - **Pediatric Considerations:** - Intraosseous access is often used for infants and children in emergency situations. - **Additional Pediatric Sites Include:** - Distal Femur. ## K. Subcutaneous Infusion Devices - **Overview** - Subcutaneous infusion is a safe, cost-effective, and convenient alternative to intravascular drug administration for certain therapies. - Medications and fluid move through the extracellular matrix to reach capillaries and lymphatics for absorption into the vascular system. - Subcutaneous medications must be absorbed into the vascular system, which may delay onset of action although bioavailability of drug is similar to that of intravenous medications. - Coadministration of human recombinant hyaluronidase facilitates drug absorption by reducing the viscosity of the extracellular matrix as the fluid as it migrates toward the vascular system. - Hyaluronidase should be added to infusions > 1000 mL. - Consider using an infusion pump to monitor and regulate medication infusions. - Isotonic fluid infusions can be managed via gravity. - **Indications/Contraindications** - **Indications:** - Medications appropriate for this route of administration include, but are not limited to: - Isotonic hydration (hypodermoclysis). - Immunoglobulin products. - Insulin. - Opioids. - Deferoxamine. - Certain monoclonal antibodies (mAb). - **Contraindications** - Poor tissue integrity at the site (i.e., trauma, infection, or rash). - Inadequate subcutaneous tissue at the proposed insertion site. - **Site Selection:** - An access device is placed in the fatty tissue below the skin. - Catheter should terminate in the subcutaneous space, which is located below the dermis and above the muscle. - Devices to access the subcutaneous tissue include items manufactured specifically for this use can be placed per manufacturer direction, typically at a 90° angle. - For continuous access, use a device that utilizes an indwelling plastic canula versus a steel needle. - Alternatively, small gauge (24-27 g) over the needle catheters, approximately ½ inch in length can be inserted at 10-45° angle (depending on thickness of tissue) into the subcutaneous space. - **Insertion/Care and Maintenance:** - Choose an access site that has adequate subcutaneous tissue (upper arm, upper back, anterior thighs, and abdomen (A minimum of 2 inches away from umbilicus). ## L. Dialysis or Apheresis Catheter - **Indications/Contraindications** - **Indications:** - Hemodialysis. - Apheresis - most commonly for plasma or platelets but also used in the treatment of conditions where disease provoking elements are removed. Rarely used for infusion. - **Contraindications:** - Neck or chest sites may be excluded for patients with: - Tracheostomies. - Radical neck dissection. - Cervical fracture instability. - Unstable airway. - Inability to position patient, insert or stabilize catheter. - **Site and Vessel Selection:** - Jugular or femoral vein. - **Insertion Procedures and Supplies** - **General Considerations**