Skip to main content

Peripherally Inserted Central Catheters

For PICC line isertion choose the Basilic Vein (medial antecubital vein),because it has Larger diameter(8mm) compared to Cephalic(lateral) 6mm,also i has  straight course

PICC have low risk of infection ,and can be left in place for 30 days

PICC pneumothorax risk is Zero

On the Other hand PICC have higher incidence of thrombosis,becuase of smaller diameter(2x higehr risk of venous thrombosis)

PICC can be used to measure CVP,CVP recorded via PICC lines are about 1 mm Hg higher than CVP from centrally inserted venous catheters.

Heparinized saline should be infused at arte of 3ml/hr,because of narrow and long course.

Bonizzoli M et al. Intensive Care Med 37: 284, 2011
Central venous pressure measurements: Peripherally inserted catheters versus centrally inserted catheters - Critical Care Medicine. 28(12):3833-3836, December 2000.
Labels:

Comments

Post a Comment

Popular posts from this blog

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more

Lumbar and thoracic epidural in Pediatrics-Technical aspect

The midline approach is most commonly used. The ligamentum   flavum is considerably thinner and less dense in infants than in older children and adults. This makes recognition of engagement in the ligament more difficult and requires both extra care and slower, more deliberate passage of the needle to avoid subarachnoid puncture. The angle of approach to the epidural space is slightly more perpendicular to the plane of the back than in older children and adults, owing to the orientation of the spinous   processes in infants and small children. The loss of resistance technique should be used, but only with saline, not air. There are several reports of venous air embolism in infants and children when air was used to test for loss of resistance Use a short (5 cm) 18-gauge Tuohy needle and a 20- or 21-gauge catheter in infants and children. Epidural kits specifically for infants and children are available Maximum of 0.4 mg/kg/hr of bupivacaine after the initial block is estab...
Post a Comment
Read more

Steroids In Perioperative period...The Multi-purpose Drugs

1-Steroids are not Bronchodilator ,but have well established usefulness in hyper-reactive airway. They are also said to have a permissive role for bronchodilator medication. They can be administered orally, parenterally or in aerosol form 2- Steroids have been commonly used in chemotherapy for prevention of nausea along with other anti-emetic agents . Dexamethasone was found to be highly effective when given immediately before induction rather than at the end of anesthesia . 3- Steroids do exert analgesic effects. Various routes of administration of steroids include parentral, local infiltration at operated site , as an adjuvant in nerve blocks and central-neuraxial blockade. 4 - Steroids cannot be the mainstay of therapy in anaphylaxis because of the delayed onset of action, so they are used as adjunct after initial treatment with epinephrine. 5- Steroids (Dexamethsone) are of value in reduction or prevention of cerebral edema associated with parasitic infections and neopla...
1 comment
Read more