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Performing and assisting advanced nursing procedures.pptx
- 1. Performing and assistingadvanced nursing procedures A vein cut down • is a minor surgical procedure used to access a vein by making an incision in the skin and dissecting down to the vein for the insertion of a cannula or catheter. • It is commonly used in emergency or critical situations where peripheral intravenous (IV) access is difficult or impossible
- 2. Purpose • To establishreliable venous access for the administration of fluids, medications, or blood products. • To obtain blood samples for laboratory tests. • To provide long-term venous access for severely ill patients.
- 3. Indications • Emergency situations: •Hypovolemic shock or severe blood loss where peripheral veins are collapsed. • Cardiac arrest requiring immediate venous access. • Difficult IV access: • In patients with small, fragile, or inaccessible veins (e.g., severe dehydration, edema, or burns). • Administration of medications or fluids: • Urgent administration of life-saving drugs or fluids when other IV access is unavailable.
- 4. Equipment • Sterile drapes •Sterile gloves • Antiseptic solution (e.g., chlorhexidine or iodine-based solution) • Scalpel with blade (e.g., #11 or #15 blade) • Tissue scissors (blunt-ended for dissection) • Forceps (e.g., toothed and non-toothed) • Hemostats or mosquito clamps (for controlling bleeding and handling the vein)
- 5. Cont.… • Intravenous cannulaor catheter (appropriate size, e.g., 14G or 16G for adults) • Needle holder (if suturing is required) • Sterile suture material (e.g., silk or nylon, 3-0 or 4-0) • Sterile gauze or sponges • Adhesive tape or securing device
- 6. Cont.… • Local anesthetic(e.g., lidocaine 1-2%) • Syringe (5-10 mL) for drawing up the anesthetic • Needles for infiltration (e.g., 25G or 27G) • IV fluid set or infusion tubing • 0.9% Normal Saline or other appropriate IV fluids for flushing the catheter • Syringe (10 mL) for flushing • Tourniquet (to distend the vein during dissection) • Bandages and sterile dressing for wound care • Disposable sharps container for proper disposal of needles and blades
- 7. Contraindications • Relative contraindications: •Local infection or cellulitis at the proposed site. • Severe coagulopathy or bleeding disorders (risk of bleeding at the surgical site). • Absolute contraindications: • Situations where a central line or intraosseous access is more appropriate.
- 8. Procedure • Preparation: • Obtaininformed consent (if possible in non-emergency cases). • Prepare sterile equipment (scalpel, forceps, sutures, cannula, etc.). • Ensure proper aseptic technique. • Identify the vein: • Common sites include the great saphenous vein at the ankle or the cephalic/basilic vein near the wrist. • Local anesthesia: • Administer local anesthetic if the patient is conscious and time permits. • Incision and dissection: • Make a small incision through the skin and subcutaneous tissue overlying the vein. • Use blunt dissection to expose and isolate the vein.
- 9. Cont.… • Cannulation: • Makea small incision in the vein (venotomy). • Insert the cannula or catheter into the vein and secure it with sutures. • Secure the site: • Close the skin incision if needed and dress the area with sterile dressing. • Flush the catheter to ensure patency. • Post-procedure care: • Monitor for complications (e.g., bleeding, infection, or dislodgement of the catheter
- 10. Assisting in ThoracentesisProcedure • is a medical procedure in which a needle or catheter is inserted into the pleural space to remove fluid or air for diagnostic or therapeutic purposes. Purpose: Diagnostic: • To evaluate the cause of pleural effusion (e.g., infection, malignancy, or heart failure). • To analyze pleural fluid for infection, protein levels, cytology, or other parameters. Therapeutic: • To relieve symptoms caused by large pleural effusions, such as dyspnea (difficulty breathing). • To drain air (pneumothorax) or infected fluid (empyema).
- 11. Indications • Suspected pleuraleffusion (seen on imaging studies such as chest X-ray or ultrasound). • Symptoms of large pleural effusion, such as: • Shortness of breath (dyspnea). • Chest pain. • Cough. • Suspected pneumothorax (collapsed lung due to air in the pleural space).
- 12. Contraindications: • Absolute Contraindications: •Uncooperative or combative patient. • Uncorrected severe coagulopathy or bleeding disorders. • Relative Contraindications: • Small or loculated pleural effusion (may be challenging to access). • Local skin infection or cellulitis at the puncture site. • Mechanical ventilation (increased risk of pneumothorax).
- 13. Precautions: • Use ultrasoundguidance to identify the fluid and avoid nearby organs or structures. • Monitor coagulation status (e.g., INR, platelet count) and correct abnormalities when possible. • Avoid inserting the needle below the 9th rib to prevent liver or spleen injury. • Ensure aseptic technique to prevent infection. • Closely monitor the patient for complications, such as pneumothorax, bleeding, or hypotension.
- 14. Procedure • Preparation: • Obtaininformed consent from the patient. • Ensure imaging studies (e.g., ultrasound or X-ray) confirm the location of the effusion. • Gather necessary equipment: sterile gloves, antiseptic solution, drapes, needle or catheter, syringe, collection bottles, and a sterile dressing. • Positioning: • Position the patient in a seated position, leaning forward slightly with arms supported on a table or pillow. If the patient cannot sit, a lateral decubitus position may be used. • Site Selection: • Determine the puncture site using imaging guidance. The typical site is the posterior axillary line, one or two intercostal spaces below the top of the effusion, and above the diaphragm. • Sterilization and Anesthesia: • Clean the skin with antiseptic solution and drape the area. • Administer local anesthesia (e.g., lidocaine) to numb the skin, subcutaneous tissue, and pleura.
- 15. Cont.… • Needle orCatheter Insertion: • Insert the needle along the superior edge of the rib to avoid neurovascular injury. • Advance the needle while aspirating until pleural fluid is obtained. • If using a catheter, advance it over the needle and secure it in place. • Fluid Aspiration: • Collect fluid in sterile bottles for laboratory analysis (e.g., cytology, culture, protein levels). • For therapeutic drainage, do not remove more than 1.5 liters at once to prevent re-expansion pulmonary edema. • Completion: • Remove the needle or catheter and apply pressure to the puncture site. • Cover the site with a sterile dressing. • Send fluid samples to the lab promptly. • Post-Procedure Care: • Monitor the patient for complications such as dyspnea, hypotension, or signs of pneumothorax. • Perform a post-procedure chest X-ray if indicated (e.g., to rule out pneumothorax).
- 16. Complications to MonitorFor: • Pneumothorax (collapsed lung). • Hemothorax (bleeding into the pleural space). • Infection (at the site or pleural space). • Pain or vasovagal reactions. • Re-expansion pulmonary edema.