By Samer Al-Ashqar

HEAD NURSEEMERGENCY Department

Kfsh&RC

A portacath is an implantable port device, which is positioned completely under the skin and inserted into the subclavian vein and avoid the need for repeated venepuncture or cannulation.

Used for patient who may require regular drug administration, often as an inpatient.

◙ Is the process of injection directly into the marrow of the bone .

◙ Alternative route when peripheral blood vessels are collapsed or inaccessible.

INDICATIONS FOR INTRAOSSEOUS ACCESS

Altered Level of Consciousness

Respiratory Compromise Need for immediate rapid sequence induction

Hemodynamic Instability Mass Casualty Situations

Medical or Trauma resuscitations

Difficult or impossible IV Placement

Bridge to Central Line Allowing for controlled central venous placement

Intraosseous Access = Immediate Vascular Access

CONTRAINDICATIONS FOR IO

Fracture

Infection at the insertion site

Prosthesis

Recent IO in same extremity (24 hours)

Absence of Anatomical Landmarks (Excessive

Tissue)

Distal Femur Proximal Tibia Distal Tibia Proximal Humerus

PEDIATRIC IO INSERTION SITES

REMOVE DRIVER FROM NEEDLE SET

Stabilize Needle Set while disconnecting DriverT-430 Rev, E

A stabilizer is available if needed

Stabilize Needle Set and rotate the stylet counter-clockwise

Remove stylet and dispose of in approved bio-hazard sharps container

T-430 Rev, E

REMOVAL OF THE STYLET

Confirm by noting one or more of the following:

Firmly seated catheter

Flash of blood in the catheter hub or blood on aspiration *

Pressurized fluids flow without difficulty

Pharmacologic effects

* may or may not be able to aspirate blood

Monitor the insertion site and posterior extremity for signs of extravasation

CONFIRM CATHETER PLACEMENT

T-430 Rev, E

in approved bio-hazard sharps containers

Portable sharps protector

45 mm Needle Set sharps protector

PUT STYLETS WHERE THEY BELONG . . .

T-430 Rev, E

A catheter that is inserted into the trachea through the mouth or nose in order to :

Maintain an open air passage

Deliver oxygen

Permit the suctioning of mucus

Prevent aspiration of the stomach contents

Right or left mainstemEsophagus

Secretions in ETTPatient biting the ETTKinks in ventilator circuitWater in ventilator circuit

Unilateral chest riseAbsence of air entry on one side of the chestTracheal deviation toward the unaffected lung

Lack of pressure in the ETT cuffConnections between the ETT / ventilator are secureThe ventilator circuit is free of defectThe ventilator is functioning normallyIncorrect ventilator settings

f. Power supply to ventilator (Red Outlet)

VAP bundle:

Sedation vacationHOB > 30 degreesOG tubeMeticulous oral careGastrointestinal prophylactic agentsDeep vein thrombosis prophylactics

Feeding tubes are increasingly used for long term enteral nutrition. It is used where patients cannot maintain adequate nutrition with oral intake

Prematurity Central nervous system problems Burns Head trauma Inherited metabolic disorders Gastrointestinal diseases Failure to thrive Abnormalities of the anatomy of the gastrointestinal tract Severe cleft lip/cleft palate Cancer

Satisfactory use by home caregiversLow incidence of complicationsReduction in aspiration pneumonia associated with swallowing disordersCost effective

Examine skin around site for infection/ irritationClean stoma site with sterile saline.Dry area with gauze.Rotate gastrostomy tube to prevent adherence to sides of trackWound care advice.

Tube blockagesTube dislodgementsExternal leakageUnplanned removal

Site infections

Tracheostomy are surgical procedures on the neck to open a direct airway through an incision in the trachea

Inner cannula—Smaller tube that fits inside the tracheostomy tube, which can be removed quickly if it becomes obstructed. This is often used for patients who have copious secretions.

Tracheostomy tube—An indwelling tube used to maintain patency of the tracheostomy. It can be made of metal (for long term use) or disposable plastic. The tube can be cuffed (a balloon is inflated to keep the tube in place) or uncuffed (air is allowed to flow freely around the tube). It can also be fenestrated, which allows the patient to speak.

1. Bleeding.2. Infection.3. Trach plugging.4. Granulation (scar) tissue.5. Skin necrosis.

1. Restlessness or increased irritability.2. Increased breathing (respiratory) rate.3. Heavy, hard breathing.4. Grunting, noisy breathing.5. Nasal flaring (sides of nostrils move in and out with breathing).

6. Retraction (sinking in of breastbone and skin between the ribs with each breath).7. Blue or pale color.8. Whistling from the trach tube.9. Sweating.10. Change in pattern of heart rate (less than 80 or more than 210 beats/minute).11. Bleeding from trach tube

Sterile Technique: sterile catheters and sterile gloves