Vascular Access Procedures PDF

### M ARTERIAL CATHETER - **Indications/contraindications** - **Indications** - Monitoring arterial pressure - Arterial blood gas analysis - General blood sampling - Organ specific infusions - **Contraindications** - Lack of adequate collateral...

### M ARTERIAL CATHETER - **Indications/contraindications** - **Indications** - Monitoring arterial pressure - Arterial blood gas analysis - General blood sampling - Organ specific infusions - **Contraindications** - Lack of adequate collateral circulation - **For the radial artery**: This may be determined via a modified Allen's Test or with ultrasound prior to catheter insertion - Instruct the patient to make a fist while the clinician manually occludes both the radial and ulnar arteries - Instruct the patient to open their hand (skin will have blanched) - Clinician releases pressure from the ulnar artery observing for palmar color change - The Allen's Test is negative if blushing occurs (indicating appropriate collateral circulation) - The Allen's Test is positive if palmar color does not return to normal after 5-15 seconds (signifying the radial artery should not be punctured) - Consider also performing a doppler ultrasound exam for flow adequacy - **Site selection** - Radial, brachial, axillary, dorsalis pedis, or femoral artery ### Insertion procedures and supplies - **General considerations** - Follow all manufacturer's instructions for use - Implement proper site disinfection prior to insertion - Arterial catheters utilized for organ specific infusions are scheduled as an operative procedure or Interventional Radiology procedure - Avoid "blind-stick" attempts to access vasculature - **Supplies** - Arterial catheter device - Ultrasound and manufactured probe/cord cover for vein visualization and access - Skin disinfecting agent - Cap, mask, eye protection, sterile drape, and sterile gloves - Manufactured stabilization device - Transparent and/or antimicrobial dressing - Consider closure device - if competent and qualified to use ### N. PULMONARY ARTERY CATHETER - **Indications/contraindications** - **Indications** - Evaluating cardiovascular and/or pulmonary function, assessing shock and fluid requirements and subsequent effectiveness of fluid resuscitation and monitoring cardiac function before, during, and after cardiac surgery - Monitoring of hemodynamics - **Contraindications** - Mitral stenosis ### Right heart mass - Tricuspid or pulmonary mechanical valves - High risk of dysrhythmias - **Site and vessel selection** - The right axillary/SC or internal jugular is preferred but can be placed in either internal jugular, axillary/SC, or femoral veins - **Insertion procedure and supplies** - **General considerations** - Follow manufacturer's instructions for use - No "blind-sticks" to access veins - Implement maximum sterile barrier precautions - Cardiac monitoring is used during insertion - Post insertion care of this type of central venous catheter requires specialized knowledge and training related both to care of external parts of the catheter and understanding and interpreting of hemodynamic waveforms associated with it - **Supplies** - Pulmonary arterial catheter - Introducer sheath through which the pulmonary artery catheter will enter the vein (this sheath traditionally also has infusion port that can be utilized for fluid and medication delivery) - Sterile insertion tray - Ultrasound and manufactured probe/cord cover for vein visualization and access - Cardiac monitoring equipment - Protective transparent sleeve that maintains the sterility of the catheter while adjustments are made during the advancement and withdrawal of the catheter throughout its dwell time - Transducing equipment necessary for monitoring the advancement of the catheter through the heart and into the pulmonary artery during insertion - Wedge syringe used for inflating and deflating the balloon to facilitate catheter placement and obtain pulmonary artery wedge pressures - Transparent and/or antimicrobial dressing ### O. AQUAPHERESIS CATHETER (Peripherally Inserted) - **Indications/contraindications** - **Indications** - An Aquapheresis catheter is typically a 15-20cm, dual lumen, 6 Fr venous access device that is inserted for the purpose of ultrafiltration therapy to remove excess salt and water from the blood stream. - Diuretic resistant CHF (ultrafiltration to move excess fluid/sodium) - **Contraindications** - Lack of accessible Basilic vein in upper arm - Inappropriate catheter to vein ratio ### P. PEDIATRIC UMBILICAL CATHETER - **Anatomy** - 2 umbilical arteries - 1 umbilical vein - May access up to the 4th day of life - **Umbilical Vein Catheter** - **Indications/Contraindications** - **Indications** - Fluid and medication administration - Parenteral nutrition administration - Blood and blood component administration - Blood sampling - **Contraindications** - Poor stump condition - Acute abdomen - Omphalitis, omphalocele, necrotizing enterocolitis, peritonitis - **Insertion procedure and supplies**