Advanced IV Access

Advanced IV AccessAdvanced IV Access

Existing Central Lines are very easy to accessExisting Central Lines are very easy to access..

Arizona Paramedics may access these with proper Arizona Paramedics may access these with proper training and with proper Base Medicaltraining and with proper Base Medical Control.Control.

Different types of Existing Central LinesDifferent types of Existing Central Lines1. Hickman, Broviac,1. Hickman, Broviac,2. Groshong2. Groshong3. Port-A-Cath3. Port-A-Cath4. PICC4. PICC

Remember that Remember that these are these are

CENTRAL LINESCENTRAL LINES and must be and must be

treated with very treated with very ASEPTIC ASEPTIC

Technique. Technique.

Used for:Used for:Chemotherapy, Blood, TPA, Heparin, Other medicationsChemotherapy, Blood, TPA, Heparin, Other medications

Advantages:Advantages:Medication delivered into large vesselMedication delivered into large vesselMedication does not damage vesselsMedication does not damage vesselsPatient does not need repeated IV access needle sticksPatient does not need repeated IV access needle sticks

Disadvantages:Disadvantages:Requires surgical insertionRequires surgical insertionPneumothorax at time of insertionPneumothorax at time of insertionBleeding at siteBleeding at siteHematoma at siteHematoma at siteInfectionInfectionSite needs continual care and dressingsSite needs continual care and dressingsPort and tubing outside on chest/neckPort and tubing outside on chest/neckThrombosis formationThrombosis formation

Potential Problems

Hematoma/Bleeding at siteHematoma/Bleeding at siteApply direct pressureApply direct pressure

Infusion slow/sluggishInfusion slow/sluggishCheck for kinked tubingCheck for kinked tubingReposition patientReposition patientRaise arm on same side as catheterRaise arm on same side as catheterRoll patient to opposite sideRoll patient to opposite sideHave patient sit upHave patient sit upHave patient take deep breath or coughHave patient take deep breath or cough(Be creative) Try whatever comes to mind!!!(Be creative) Try whatever comes to mind!!!

Potential Problems

Infiltration/ExtravasationInfiltration/ExtravasationClamp tubingClamp tubing

Air embolism (respiratory distress)Air embolism (respiratory distress)Clamp catheter immediately and turn patient on left side Clamp catheter immediately and turn patient on left side with head down so air enters the right atrium and with head down so air enters the right atrium and pulmonary artery. Maintain this position for 20-30 pulmonary artery. Maintain this position for 20-30 minutes.minutes.

PORT-A-CATHPORT-A-CATHREQUIRES A SPECIAL NEEDLE FOR ACCESSING called a REQUIRES A SPECIAL NEEDLE FOR ACCESSING called a

(HUBER NEEDLE)(HUBER NEEDLE)-Non Coring Needle-Non Coring Needle

1 Wash hands thoroughly. Put on gloves1 Wash hands thoroughly. Put on gloves2.2. Aseptic techniqueAseptic technique is to be used is to be used3.3. Gather Supplies (Huber needle, syringe, IV Solution)Gather Supplies (Huber needle, syringe, IV Solution)4.4. Open Huber Needle, flush it with NS to purge air.Open Huber Needle, flush it with NS to purge air.5.5. Locate the portal septum by palpation, cleanse skin with betadine Locate the portal septum by palpation, cleanse skin with betadine

then alcohol. Inform patient that you will be inserting needle. then alcohol. Inform patient that you will be inserting needle. Insert needle.Insert needle.

6.6. Release the clampRelease the clamp on needle tubing and flush with 1cc NS on needle tubing and flush with 1cc NS7.7. Withdraw 8-10cc of blood, Withdraw 8-10cc of blood, clamp tubing,clamp tubing, remove syringe and remove syringe and

discarddiscard blood. blood.8.8. Unclamp tubingUnclamp tubing and run IV Solution at desired rate. and run IV Solution at desired rate.9.9. Place a sterile 2X2 gauze pad underneath the hub of the needle.Place a sterile 2X2 gauze pad underneath the hub of the needle.10.10. Place transparent dressing over the needle.Place transparent dressing over the needle.

Huber NeedleHuber Needle

Any QuestionsAny Questions??