Home About us Contact
|
Home About us Contact | ||
|
|
||
IV Access (iv + access)
Selected AbstractsEmergency Nurses' Utilization of Ultrasound Guidance for Placement of Peripheral Intravenous Lines in Difficult-access PatientsACADEMIC EMERGENCY MEDICINE, Issue 12 2004Larry Brannam MD Objectives: Emergency nurses (ENs) typically place peripheral intravenous (IV) lines, but if repeated attempts fail, emergency physicians have to obtain peripheral or central access. The authors describe the patient population for which ultrasound (US)-guided peripheral IVs are used and evaluate the success rates for such lines by ENs. Methods: This was a prospective observational study of ENs in a Level I trauma center with a census of 75,000, performing US-guided IV line placement on difficult-to-stick patients (repeated blind IV placement failure or established history). ENs were trained on an inanimate model after a 45-minute lecture. Surveys were filled out after each US-guided IV attempt on a patient. ENs could decline to fill out surveys, which recorded the reason for use of US, type of patient, and success. Successful cannulation was confirmed by drawing blood and flushing fluids. Descriptive statistics were used to evaluated data. Results: A total of 321 surveys were collected in a five-month period no ENs declined to participate. There were 280 (87%) successful attempts. Twelve (29%) of the 41 failure patients required central lines, 9 (22%) received external jugular IVs, and 20 (49%) had peripheral IV access placed under US guidance by another nurse or physician. Twenty-eight percent (90) of all patients were obese, 18% (57) had sickle cell anemia, 10% (31) were renal dialysis patients, 12% (40) were IV drug abusers, and 19% (61) had unspecified chronic illness. The remainder had no reason for difficult access given. There were four arterial punctures. Conclusions: ENs had a high success rate and few complications with use of US guidance for vascular access in a variety of difficult-access patients. [source] What You See (Sonographically) Is What You Get: Vein and Patient Characteristics Associated With Successful Ultrasound-guided Peripheral Intravenous Placement in Patients With Difficult AccessACADEMIC EMERGENCY MEDICINE, Issue 12 2009Nova L. Panebianco MD Abstract Objectives:, Ultrasound (US) has been shown to facilitate peripheral intravenous (IV) placement in emergency department (ED) patients with difficult IV access (DIVA). This study sought to define patient and vein characteristics that affect successful US-guided peripheral IV placement. Methods:, This was a prospective observational study of US-guided IV placement in a convenience sample of DIVA patients in an urban, tertiary care ED. DIVA patients were defined as having any of the following: at least two failed IV attempts or a history of difficult access plus the inability to visualize or palpate any veins on physical exam. Patient characteristics (demographic information, vital signs, and medical history) were collected on enrolled patients. The relationships between patient characteristics, vein depth and diameter, US probe orientation, and successful IV placement were analyzed. Results:, A total of 169 patients were enrolled, with 236 attempts at access. Increasing vessel diameter was associated with a higher likelihood of success (odds ratio [OR] = 1.79 per 0.1-cm increase in vessel diameter, 95% confidence interval [CI] = 1.37 to 2.34). Increasing vessel depth did not affect success rates (OR = 0.96 per 0.1-cm increase of depth, 95% CI = 0.89 to 1.04) until a threshold depth of 1.6 cm, beyond which no vessels were successfully cannulated. Probe orientation and patient characteristics were unrelated to success. Conclusions:, Success was solely related to vessel characteristics detected with US and not influenced by patient characteristics or probe orientation. Successful DIVA was primarily associated with larger vessel, while vessel depth up to >1.6 cm and patient characteristics were unrelated to success. Clinically, if two vessels are identified at a depth of <1.6 cm, the larger diameter vessel, even if comparatively deeper, should yield the greatest likelihood of success. [source] Longitudinal mapping of mouse cerebral blood volume with MRINMR IN BIOMEDICINE, Issue 5 2006Herman Moreno Abstract MRI estimations of cerebral blood volume (CBV), useful in mapping brain dysfunction, typically require intravenous (IV) injections of contrast agents. Transgenically engineered mice have emerged as the dominant animal model with which to investigate disorders of the brain and novel therapeutic agents. The difficulty in gaining IV access in mice prohibits repeated administration of contrast in the same animal, limiting the ability to map CBV changes over time. Here we address this limitation by first optimizing an approach for estimating CBV that relies on intraperitoneal (IP) rather than IV injections of the contrast agent gadodiamide. Next, we show that CBV maps generated with IP or IV injections are quantitatively comparable. Finally, we show that CBV maps generated with IP gadodiamide can be acquired repeatedly, reliably and safely over time. Although this approach has certain limitations, estimating CBV with IP injections is well-suited for mapping the spatiotemporal pattern of brain dysfunction in mice models of disease, and for testing pharmacological agents. Copyright © 2006 John Wiley & Sons, Ltd. [source] 10 A Rapid, Simple and Inexpensive Method for Construction of Peripheral Vascular Ultrasound PhantomsACADEMIC EMERGENCY MEDICINE, Issue 2008Hal Minnigan Background and Introduction:, Emergency department bedside ultrasound has grown to include ultrasound guidance of vascular access, most recently, peripheral IV access has been described with ultrasound guidance. Simulation of procedures that are crucial to clinical practice is an efficient and reliable way to train and assess competency prior to performance on an actual patient. Ultrasound phantoms that simulate patient anatomy allow the development of hand-eye coordination, orientation and manipulation of the instruments in a controlled setting. In an effort to obviate the cost of commercial products I have developed a very simple and rapid method for building vascular ultrasound phantoms for teaching ultrasound guided peripheral IV placement. Materials and Methods:, Using easily obtainable and inexpensive materials, a simple method is described which allows construction of the phantom in less than 1 hour. This method requires no special tools or construction skills. The total cost for 1 phantom is about $30.00. Most of the components can be reused when the phantom needs to be repoured , the cost to repour a phantom is less than 2. Results:, These phantoms are realistic in terms of visualization of deep upper extremity veins, and include fluid filled vessels which are gravity fed by colored saline. The system is versatile and can be customized to fit the needs of the individual user. Attendees will be provided with a CD comprising a complete materials list with sources of supply, a PowerPoint presentation to guide construction with each step detailed using digital photographs, and videos of use of the phantom. [source] | ||||||||||