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.

Comments

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by: the area of the curve the slope of the line from points C to D the distance of the line from points C to D the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by: the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body

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...

sedationstation

Search This Blog