Confirmation of intravenous location - Vascular access

 Confirmation of intravenous location

Several techniques can help to confirm that the needle is not in an artery – usually the carotid. While pulsatility and a bright red color are good hints, they are not foolproof.

·           If ultrasound guidance was used to place the catheter (as is routine at our insti-tution), use it to confirm position as well.

·           Attach a length of sterile clear tubing to the needle hub and lower the end, allowing it to fill several centimeters with blood, then raise above the patient’s heart level. A rising column of pulsating blood confirms arterial location, while a column that reflects the central venous pressure is a more welcome finding.


Comments

Post a Comment

Popular posts from this blog

Early post-operative care - Anesthesia

Image
  Post-operative care The post-operative care of the patient can be divided into an early and a continued phase. The early phase lasts from the moment the patient leaves the operating room until he is discharged from the Post-Anesthesia Care Unit (PACU) or its equi-valent. The care is then continued, a phase that can extend for days or even weeks. Early post-operative care Based on his medical condition and the planned operative procedure, we will have classified the patient as ambulatory (also known as outpatient), as ‘post-operative admit’ (the patient comes to the hospital on the day of the operation and is admitted to the hospital after his operation), or as an inpatient (the patient is already in the hospital, or will be admitted for pre-operative preparation, and will stay there post-operatively). Two categories of patients might bypass the PACU (formerly called the Recovery Room): (i) ambulatory patients who had a minor procedure and are expected to be ready for discharge in a m
Read more

Fluid requirements - Fluid management

Image
  Fluid requirements We calculate the intra-operative fluid requirement as follows:   ·             Maintenance  The 4–2–1 rule (Table 3.7 )provides a guide for hourly isotonicfluid requirements.   For a 70 kg man, this would amount to 40  +  20  +  50  =  110 mL/h.   ·             Fasting replacement  We apply the 4–2–1 rule for the duration of fasting andreplace 50% over the first hour, then 25% over each of the next two hours. ·             Insensible losses  2 mL/kg/h.   ·             Urine output  Replaced mL for mL.   ·             “ Third space ”  losses  Transfer of fluid to this sequestered, extravascular space occurs with surgical trauma, and must be replaced with isotonic solution in the short-term: 4–8 mL/kg/h depending on the degree of surgical trauma, e.g., peripheral operation vs. open abdomen.   ·             Blood loss  We replace small amounts with crystalloid (3 mL per mL bloodlost); in larger resuscitations, colloid and/or blood is administered 1:1 with blood loss.
Read more

Treatment for Diseases of the Spinal Cord - Myelopathy

  Treatment : A complete diagnosis is very important for necessary treatment. If the disease is due to the compression of the spinal cord, it is important to decide if surgery is possible or not. Surgeries ranging from, long, complicated microsurgery; to the surgeries to dissolve tumors with the help of ultrasound (CUSA) are now available in our country. Surgery of the spinal cord is normally not dangerous, but it is undeniable that the operation has to be done very delicately, skillfully and systematically, because the spinal cord is very narrow and congested with innumerable nerve fibres. Thus, to prevent any damage, the surgeon has to be very cautious during surgery. The non-compressive disorders are treated according to the underlying cause like: ·             Treatment for TB. ·             Use of steroids for the treatment of multiple sclerosis and other demyelinating diseases, as well as collagen diseases.   ·             Vitamin deficiency is treated accordingly.... etc. Specif
Read more