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By Samer Al-Ashqar HEAD NURSE EMERGENCY Department Kfsh&RC.

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Presentation on theme: "By Samer Al-Ashqar HEAD NURSE EMERGENCY Department Kfsh&RC."— Presentation transcript:

1 By Samer Al-Ashqar HEAD NURSE EMERGENCY Department Kfsh&RC

2 A portacath is an implantable port device, which is positioned completely under the skin and inserted into the subclavian vein and avoid the need for repeated venepuncture or cannulation. Used for patient who may require regular drug administration, often as an inpatient.




6 Is the process of injection directly into the marrow of the bone.injectionmarrow Alternative route when peripheral blood vessels are collapsed or inaccessible.


8 INDICATIONS FOR INTRAOSSEOUS ACCESS Altered Level of Consciousness Respiratory Compromise Need for immediate rapid sequence induction Hemodynamic Instability Mass Casualty Situations Medical or Trauma resuscitations Difficult or impossible IV Placement Bridge to Central Line Allowing for controlled central venous placement Intraosseous Access = Immediate Vascular Access

9 CONTRAINDICATIONS FOR IO Fracture Infection at the insertion site Prosthesis Recent IO in same extremity (24 hours) Absence of Anatomical Landmarks (Excessive Tissue)

10 Distal FemurProximal TibiaDistal TibiaProximal Humerus PEDIATRIC IO INSERTION SITES

11 REMOVE DRIVER FROM NEEDLE SET Stabilize Needle Set while disconnecting Driver T-430 Rev, E

12 A stabilizer is available if needed Stabilize Needle Set and rotate the stylet counter-clockwise Remove stylet and dispose of in approved bio-hazard sharps container T-430 Rev, E REMOVAL OF THE STYLET

13 Confirm by noting one or more of the following: Firmly seated catheter Flash of blood in the catheter hub or blood on aspiration * Pressurized fluids flow without difficulty Pharmacologic effects * may or may not be able to aspirate blood Monitor the insertion site and posterior extremity for signs of extravasation CONFIRM CATHETER PLACEMENT T-430 Rev, E


15 in approved bio-hazard sharps containers Portable sharps protector 45 mm Needle Set sharps protector PUT STYLETS WHERE THEY BELONG... T-430 Rev, E

16 A catheter that is inserted into the trachea through the mouth or nose in order to : Maintain an open air passage Deliver oxygen Permit the suctioning of mucus Prevent aspiration of the stomach contents


18 Right or left mainstem Esophagus

19 Secretions in ETT Patient biting the ETT Kinks in ventilator circuit Water in ventilator circuit

20 Unilateral chest rise Absence of air entry on one side of the chest Tracheal deviation toward the unaffected lung

21 Lack of pressure in the ETT cuff Connections between the ETT / ventilator are secure The ventilator circuit is free of defect The ventilator is functioning normally Incorrect ventilator settings f. Power supply to ventilator (Red Outlet)

22 VAP bundle: Sedation vacation HOB > 30 degrees OG tube Meticulous oral care Gastrointestinal prophylactic agents Deep vein thrombosis prophylactics


24 Feeding tubes are increasingly used for long term enteral nutrition. It is used where patients cannot maintain adequate nutrition with oral intakeenteral nutrition

25 Prematurity Central nervous system problems Burns Head trauma Inherited metabolic disorders Gastrointestinal diseases Failure to thrive Abnormalities of the anatomy of the gastrointestinal tract Severe cleft lip/cleft palate Cancer

26 Satisfactory use by home caregivers Low incidence of complications Reduction in aspiration pneumonia associated with swallowing disordersaspiration pneumonia Cost effective

27 Examine skin around site for infection/ irritation Clean stoma site with sterile saline. Dry area with gauze. Rotate gastrostomy tube to prevent adherence to sides of track Wound care advice.

28 Tube blockages Tube dislodgements External leakage Unplanned removal Site infections


30 Tracheostomy are surgical procedures on the neck to open a direct airway through an incision in the tracheasurgical trachea

31 Inner cannula Smaller tube that fits inside the tracheostomy tube, which can be removed quickly if it becomes obstructed. This is often used for patients who have copious secretions.

32 Tracheostomy tube An indwelling tube used to maintain patency of the tracheostomy. It can be made of metal (for long term use) or disposable plastic. The tube can be cuffed (a balloon is inflated to keep the tube in place) or uncuffed (air is allowed to flow freely around the tube). It can also be fenestrated, which allows the patient to speak.

33 1. Bleeding. 2. Infection. 3. Trach plugging. 4. Granulation (scar) tissue. 5. Skin necrosis.

34 1. Restlessness or increased irritability. 2. Increased breathing (respiratory) rate. 3. Heavy, hard breathing. 4. Grunting, noisy breathing. 5. Nasal flaring (sides of nostrils move in and out with breathing).

35 6. Retraction (sinking in of breastbone and skin between the ribs with each breath). 7. Blue or pale color. 8. Whistling from the trach tube. 9. Sweating. 10. Change in pattern of heart rate (less than 80 or more than 210 beats/minute). 11. Bleeding from trach tube

36 Sterile Technique: sterile catheters and sterile gloves


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