Implications of Precise PICC Tip Location: The New Gold Standard in Clinical Practice?
|
|
- Lynn Harmon
- 5 years ago
- Views:
Transcription
1 Implications of Precise PICC Tip Location: The New Gold Standard in Clinical Practice? Nancy Moureau, BSN, CRNI, CPUI, PICC Excellence, Inc. About the Speaker Nancy Moureau is an educator, legal consultant and clinician with 30 years of vascular access experience PICC Trainer and expert witness in legal cases for more than 21 years IV/PICC Team prn staff nurse with Greenville Memorial CEO and Owner of PICC Excellence an educational company Speaker Bureau for: 3m Access Scientific AngioDynamics Teleflex, Inc. Cook Excelsior Objective Evaluate clinical practices and legal implications of tip positioning for most accurate and precise placement of peripherally inserted central catheters Accuracy versus Precision Accuracy the degree of closeness/proximity to the true value High accuracy low precision Close to value, but no bulls-eye Precision reflects the degree of reproducibility/ repeatability in accomplishing the target value Wikipedia accessed 4/6/12 Hostetter, et al. Precision in CVC Tip Placement JAVA 2010;15(3): High precision low accuracy All in one area, but no bulls-eye Accuracy versus Precision Accuracy AND Precision Matter Why do we need both accuracy and precision? Ideally CVC placement is both accurate and precise with terminal tip both close to and positioned at the target area Because, medically speaking, close is just not good enough anymore Target Migration Looping Azygos Vein Tip on the wall Tricuspid Valve AV Node Superior Vena Cava/Cavoatrial Junction TM Suboptimal tip placement increases risk of many complications Thrombosis up to 16x higher Higher rates of occlusion and loss of function Increased risk of infection with relationship to thrombosis Malposition flipping into internal jugular more common 2cm 1
2 Goals of Terminal Tip Confirmation Designed to: Verify placement in vein versus artery Reduce complications associated with malpositioning Reduce liability from terminal tip complications Establish catheter tip into optimal high flow area Promote patient safety Why Distal SVC near Cavo Atrial Junction? Established as standard by FDA CVC Working Group in 1994 Included in instructions for use by manufacturers Reduces potential for malpractice Why is Tip Location Important? 45.2% 87% 19% 31% 4.2% 18% 1.5% 0-2% 5.6% 5.6% Caers J, et al. Catheter Tip Position as a risk factor for thrombosis associated with the use of subcutaneous ports. Support Care Cancer : Petersen et al, Silicone Venous Access Devices Positioned with Their Tips High in the Superior Vena Cava Are More Likely to Malfunction, Am J Surg 1999, 178:38-41 (Special thanks to Lorelle Wuerz) Case Study Clinical Applications Potential for Malpractice Situation - Emergency transport Background 10 year old boy receiving long-term medications at home. MD ordered recheck of PICC placement after 4 months when pt having mild SOB. Prior to X-ray pt developed acute SOB, anxiety, then cardiac arrest. Cause Catheter was positioned in right atrium Eroded through the heart wall Resulted in cardiac tamponade Action 911 Patient died en-route to hospital Malpractice potential, huge, which was why I was contacted. Original confirmation was deep. Solution Accuracy and Precision the first time Pinpointing for Safety and Reduced Liability Precision Matters What Position for X-Ray? Upper RA placement increases risk Factors Moving Tip Upward or Downwards External Landmark Without Guidance Magnetic Tip Navigation ECG Guidance ECG with Doppler 1. Trerotola et al. J Vasc Interv Radiol 2007; 18: Naylor JAVA 2007:12:1: Starr et al, Ann Surg, 1986: Salmela et al. Acta Anaesthesiol Scand 1993: 37: Hostetter, et al. Precision in CVC Tip Placement JAVA 2010;15(3): cm 2-4 cm 1-2cm Catheter induced Afib or V-Tach Other RA wall related complications Irritation from TPN and other high osmotic solutions creating thrombosis risk Increased infection risk - thrombosis and infection related SVC 2cm Cavo Atrial Junction R Atrium 2
3 SVC Pulse Doppler Case Study Situation Friday 4pm PICC placement requiring confirmation prior to use Background 72 yo female requires PICC for fluids, K+ and medications. Radiologist leaves at 16:30, PICC nurse not authorized to read films. X-ray report dictated PICC in the IJ Action choices Remove (patient required access) Wait for catheter to drop (no PICC nurse available S/S) Pull back to alternative position (K+ is an irritant) Replace with new insertion or exchange Nurse pulled catheter back no X-ray recheck Response LOC change within 24 hours, pt confused, died within 48 hours Cause Arterial placement Potential for Malpractice Radiologist misread film (too difficult to differentiate vein from artery up the neck final report PICC in vertebral artery), Nurse did not correct or confirm the placement, cleared the line for use. Nurse suspended from work. Patient s family sued, hospital settled for undisclosed amount. Solution Better forms of confirmation that allow location pinpoint during insertion, and vein and artery differentiation. Target Area Superior Vena Cava/CAJ Complications Cause Result Cardiac Arrythmias Arterial Access Erosion through vein wall Thrombosis Erosion through heart wall Pulmonary Emboli Cardiac Tamponade Positioning too deep, malposition or in artery High position of terminal tip Left sided position without making downward turn into SVC Irritation to vein wall. Suboptimal position high in SVC, subclavian or collateral veins Positioning in the right atrium or ventricle Coagulation and thrombotic development resulting in emboli blocking pulmonary artery into lungs Erosion of catheter through heart wall allowing infusion of solutions into the pericardium Atrial fibrillation, flutter, premature ventricular contractions, emboli, stroke Infusion into pleural space. Failure to achieve blood return Pneumonia, infiltrates, abscess Poor function, lack of blood return, pulmonary emboli, post thrombotic sequellae Compromise of heart function, cardiac tamponade with 70% mortality Difficulty breathing, chest pain, palpitations and sudden death Pericardial effusion results in pressure on the heart resulting in decreased cardiac function and death Measuring Liability Levels of success with Landmark: 46-75% 2,3,4,5 Success with Magnetic navigation: 80% 3 Success with ECG: 55-88% 6,7 Since SA node is located near the CAJ in the posterior wall of the right atrium, the P-wave acts like a beacon used to guide a catheter tip, towards the CAJ ECG and Doppler potential success 95% or greater 8 References: 2. Trerotola et al. J Vasc Interv Radiol 2007; 18: Naylor JAVA 2007; 12:1: VSN Market Research 5. Hostetter, R. et al JAVA 15:3, Starr et al, Ann Surg, 1986; Salmela et al. Acta Anaesthesiol Scand 1993; 37: Clinical data on file at VasoNova, Inc. 15 Liability Issues Performing tip confirmation: Where is the risk? Where is the safety? X-ray The Current Standard Simple chest X-ray confirmation Frequently difficult to read General area validation. Placement frequently too deep or too shallow (10-15%) Malpositions: 5-8% in IJ, 3-5% contra-lateral or looped back 1D flat film reading missing Azygos and other malpositions More than 50% need some kind of adjustment after first placement Failure to differentiate arterial placement ECG Confirmation Greater accuracy and precision Requires discernible P-wave and interpretation Measures changes in P-wave once reaching superior vena cava Requires understanding of P-wave polarization and depolarization Unable to detect arterial placement Improved accuracy and precision ECG with Doppler Confirmation Same advantages as with ECG Indicates position or malposition with flow indicator Detects arterial flow Combined use designed to measure target location and provide all clear Blue Bullseye indication Broad application for accuracy and precision with cardiac patients No interpretation required Reducing Potential for Malpractice How can you effectively reduce the potential for malpractice? By developing processes that promote consistent outcomes greater than 95% of the time Provide confirmation in timely manner with insertion while ruling out arterial placement Put the tools in the hands of the inserter X-Ray General location for terminal tip Accurate most of the time Is that good enough? ECG/EKG Greater accuracy and precision, applicable to most patients with P-wave ECG/EKG + Doppler Achieves maximum accuracy, precision and safety, greatest application Doppler Principles for Tip Position Flow in veins is pulsatile driven by heart cycle hemodynamics Systolic inflow S D A Atrial Contraction Diastolic inflow 3
4 TEE IMAGING Doppler Flow Signatures Pt No. 2 Sinus rhythm: SVC-RA Junction RA inflow blood flow away from the transducer = Antegrade flow Proximal SVC Mid SVC CAJ Blood flow towards the transducer = Retrograde flow RA +1 cm Catheter Position and Precision Establishing the best position for a catheter tip involves knowing how to place the tip at the upper edge of Blue Bullseye zone for SVC lower 1/3 and CAJ placements 21 Move the tip upwards by 1cm or smaller steps Once reaching transient Blue Bullseye or Green Arrow, reposition tip until stable Blue Bullseye is achieved. Watch Doppler signal for balanced flow signature Improving the Process and Making it Happen Gain support Medical director/unit director/nurse executive proposal Outline savings of time and dollars Faster time to use reduces liability Improved outcomes with more rapid time to treatment Recovery time reduced thus impacting length of stay Improving the Process and Making it Happen Changing policies and processes requires evaluation of the old with new process Establish evaluation comparison in coordination with radiology X-ray readings in correlation with ECG/Doppler documentation Set up a specific number of correlations rather than a timeframe more effective. Use established X-ray guidelines that reduce variables Example: PICC placements with X-ray = ECG/Doppler reading of CAJ readings Submit for approval with your proof of correlated readings and evidence of equal or greater performance Draft the policy changes with radiology Allow a safety check and include order for X-ray any time there is position question or patient that is within limitations of device Maintain documentation of evaluation as evidence Accuracy + Precision + Safety Which do you consider optional? Accuracy Precision Or Safety For greatest reduction in terminal tip malposition all three Accuracy, Precision and Safety are vital To minimize liability - Safeguard your patients with processes that correctly determine terminal tip location ECG + Doppler = Safe Position 4
5 Questions? References Cadman A, Lawrence J., Fitzsimmons L, Spencer-Shaw A, Swindell R. To clot or not to clot? That is the question in central venous catheters. Clinical Radiology 2004;59: Crowley AL, Peterson GE, Benjamin DK Jr, et al. Venous thrombosis in patients with short- and long-term central venous catheter-associated Staphylococcus aureus bacteremia. Crit Care Med 2008;36: Gebhard RE, et al The Accuracy of Electrocardiogram-Controlled Central Line Placement. Anesth and Analg 2007;104(1): Grove, J., Pevec, W. Venous thrombosis related to peripherally inserted central catheters.. J Vasc Interv Radiol, 2000;11(7): Hostetter R, Nakazawa N, Tompkins K, Hill B. Precision in Central Venous Catheter Tip Placement: A Review of the Literature. JAVA 2010;15(3): Infusion Nurses Society (2011) Infusion Nursing Standards of Practice Revised Supp: 34(15):S1-S110. Nancy Moureau Thank You, Teleflex for Sponsorship nancy@piccexcellence.com Kearns PJ, Coleman S, Wehner JH. Complications of long arm catheters: A randomized trial of central vs peripheral tip location. Journal of Parenteral and Enteral Nutrition. 1996;20: McGee W, Ackerman B, Rouben L, Prasad V, Bandi V, Mallory, D. Accurate placement of central venous catheters: a prospective, randomized, multicenter trial. Critical Care Medicine, 1993;21(8): Meyer BM. Managing Peripherally Inserted Central Catheter Thrombosis Risk: A Guide for Clinical Best Practice. Jour Assoc Vas Access. 2011;16(3): Moureau N, et al. Electrocardiogram (EKG) Guided Peripherally Inserted Central Catheter Placement and Tip Position: Results of a Trial to Replace Radiological Confirmation. 2010;15(1):9-14. Nakazawa N. Changes in the Accurate Identification of the Ideal Catheter Tip Location. Journ Assoc Vas Acc 2010;15(4): Nakazawa N. Infectious and Thrombotic Complications of Central Venous Catheters. Seminars in Oncology Nsg 2010;26(2): Pittiruti, M., Scoppettuolo, G., LaGreca, A., Emoli, A., Brutti, A., Migliorini, I., et al. The EKG method for positioning the tip of PICCs: results from two preliminary studies, JAVA 2008;3(4): Scott WL, Kondratovich M, Blum D. Central venous catheter tip placement and catheter occlusion. Am Jour Surg 2000, 180(1): Starr D, Cornicelli S. EKG guided placement of subclavian CVP catheters using j-wire. Ann. Surg, 1986;204(6): Tierney, S., Katke, J., & Langer, J. Cost Comparison Of Electrocardiography Versus Fluoroscopy For Central Venous Line Positioning In Children, J. Am. Coll. Surg. 2000;91(2): Timsit JF et al. Central Vein Catheter-Related Thrombosis in Intensive Care Patients: Incidence, Risk Factors and Relationship with Catheter-Related Sepsis. Chest 1998;114(1): Trerotola S, Thompson, S, Chittams J, Vierregger K. Analysis of tip malposition and correction in peripherally inserted central catheters placed at bedside by a dedicated nursing team. J Vasc Interv Radiol, 2007;18, Van Rooden CJ, et al. Infectious Complications of CVCs Increase Risk of Catheter Related Thrombosis in Hematology Patients: A Prospective Study ASCO 23(12): Vesely, T. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol, 2003;14(5):
Caroline Polley, BSN, RN, VA-BC Clinical Specialist BD
Caroline Polley, BSN, RN, VA-BC Clinical Specialist BD Disclosures The speaker is a employee of BD. (Please consult BD product for any indications, contraindications, hazards, warnings, cautions and instructions
More informationComparison Between Novel Tip Positioning Technology using ECG and Doppler and 2-D Echocardiography for the Placement of Central Catheters
Comparison Between Novel Tip Positioning Technology using ECG and Doppler and 2-D Echocardiography for the Placement of Central Catheters Robert Wagner, MD, PhD 1, Petr Pokorny, MD 1, Jiri Cernosek, Dr.
More informationResearch Article Can we predict the Position of Central Venous Catheter Tip Following Cannulation of Internal Jugular Vein?
Cronicon OPEN ACCESS ANAESTHESIA Research Article Can we predict the Position of Central Venous Catheter Tip Following Cannulation of Internal Jugular Vein? Pradeep Marur Venkategowda 1, Surath Manimala
More informationMary Lou Garey MSN EMT-P MedFlight of Ohio
Mary Lou Garey MSN EMT-P MedFlight of Ohio Function Prolonged and frequent access to venous circulation Allows for patient to carry on normal life; decrease number of needle sticks Medications, parenteral
More informationNavigating Vascular Access Issues
Navigating Vascular Access Issues The Oley Foundation 27 th Annual Consumer/Clinician Conference Redondo Beach, CA June, 27 2012 Anita Piano, BS, RN, VA-BC Administrative Nurse, PICC Service UCLA Health
More informationJMSCR Vol 05 Issue 10 Page October 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 71.58 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i10.79 Original Article Bedside Prediction of
More informationOver the Wire Technique vs. Modified Seldinger Technique in Insertion of PICC
Over the Wire Technique vs. Modified Seldinger Technique in Insertion of PICC Deniz Kasikci Department of Radiology, Jena University Hospital Friedrich-Schiller-University, Jena, Germany Disclosure Speaker
More informationTip navigation and tip location for PICCs. Mauro Pittiruti Catholic University, Rome - Italy
Tip navigation and tip location for PICCs Mauro Pittiruti Catholic University, Rome - Italy What are we talking about? Tip navigation and tip location are two different aspects of central line insertion:
More informationThe C.L.O.T. Tool for Identifying Strategies to Prevent PICC Catheter Occlusions
The C.L.O.T. Tool for Identifying Strategies to Prevent PICC Catheter Occlusions page 2 TABLE OF CONTENTS Part 1: Definition and Scope of Catheter Occlusion Part 2: Predictors of Catheter Occlusion Part
More informationHemodynamic Monitoring
Perform Procedure And Interpret Results Hemodynamic Monitoring Tracheal Tube Cuff Pressure Dean R. Hess PhD RRT FAARC Hemodynamic Monitoring Cardiac Rate and Rhythm Arterial Blood Pressure Central Venous
More informationThe carina as a radiological landmark for central venous catheter tip position
British Journal of Anaesthesia 96 (3): 335 40 (2006) doi:10.1093/bja/aei310 Advance Access publication January 16, 2006 The carina as a radiological landmark for central venous catheter tip position P.
More informationMR Advance Techniques. Cardiac Imaging. Class IV
MR Advance Techniques Cardiac Imaging Class IV Heart The heart is a muscular organ responsible for pumping blood through the blood vessels by repeated, rhythmic contractions. Layers of the heart Endocardium
More informationPatient Management Code Blue in the CT Suite
Patient Management Code Blue in the CT Suite David Stultz, MD November 28, 2001 Case Presentation A 53-year-old woman experienced acute respiratory distress during an IV contrast enhanced CT scan of the
More informationTITLE: Electrocardiograms versus X-rays for Guided Placement of Central Venous Catheter Tips: A Review of Clinical and Cost-effectiveness
TITLE: Electrocardiograms versus X-rays for Guided Placement of Central Venous Catheter Tips: A Review of Clinical and Cost-effectiveness DATE: 18 July 2012 CONTEXT AND POLICY ISSUES Central venous catheters
More informationPARENTERAL NUTRITION: VASCUAR ACCESS DEVICE SELECTION
PARENTERAL NUTRITION: VASCUAR ACCESS DEVICE SELECTION Winifred Magambo-Gasana Vascular Access Nurse Practitioner Oxford University Hospitals NHS Foundation Trust Aim An overview of the range of Vascular
More informationLab 16. The Cardiovascular System Heart and Blood Vessels. Laboratory Objectives
Lab 16 The Cardiovascular System Heart and Blood Vessels Laboratory Objectives Describe the anatomical structures of the heart to include the pericardium, chambers, valves, and major vessels. Describe
More informationREVIEWED/REVISED 12/12 DATE) MEDICAL STAFF (if applicable) DATE OTHER DATE Special Procedures Committee 10/12 Nursing Leadership Team 08/12
MANUAL: Clinical Page: 1 of 9 STANDARDIZED PROCEDURE I. POLICY: A. Function: To authorize the qualified Registered Nurses at St. Joseph Hospital (SJO) to insert Peripherally Inserted Central Catheters
More information37 1 The Circulatory System
H T H E E A R T 37 1 The Circulatory System The circulatory system and respiratory system work together to supply cells with the nutrients and oxygen they need to stay alive. a) The respiratory system:
More informationDepth of Central Venous Catheterization by Intracardiac ECG in Paediatric Patients
Original Article Elmer Press Depth of Central Venous Catheterization by Intracardiac ECG in Paediatric Patients Prerana N. Shah a, b, Jithesh Appukutty a, Deepa Kane a Abstract Background: Central venous
More informationUnit 6: Circulatory System. 6.2 Heart
Unit 6: Circulatory System 6.2 Heart Functions of Circulatory System 1. The heart is the pump necessary to circulate blood to all parts of the body 2. Arteries, veins and capillaries are the structures
More informationCentral Line Care and Management
Central Line Care and Management What is a Central Line/ CVAD? (central venous access device) A vascular infusion device that terminates at or close to the heart or in one of the great vessels (aorta,
More informationA Primer on Central Venous Access: Peripherally-Inserted Central Catheters, Tunneled Catheters, and Subcutaneous Ports
Disclosures A Primer on Central Venous Access: Peripherally-Inserted Central Catheters, Tunneled Catheters, and Subcutaneous Ports No conflicts of interest relevant to this presentation Jason W. Pinchot,
More informationYou have a what, inside you?
Costal Emergency Medicine Conference You have a what, inside you? Less than mainstream medical devices encountered in the ED. Eric Ossmann, MD, FACEP Associate Professor Duke University Medical Center
More informationEchocardiography as a diagnostic and management tool in medical emergencies
Echocardiography as a diagnostic and management tool in medical emergencies Frank van der Heusen MD Department of Anesthesia and perioperative Care UCSF Medical Center Objective of this presentation Indications
More informationYou have a what, inside you?
Costal Emergency Medicine Conference You have a what, inside you? Less than mainstream medical devices encountered in the ED. Eric Ossmann, MD, FACEP Associate Professor Duke University Medical Center
More informationCorrelation of Surface Landmarks Based Insertion Length of Right Subclavian Central Venous Catheter with Post Insertion Location of Catheter Tip
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2018/50 Correlation of Surface Landmarks Based Insertion Length of Right Subclavian Central Venous Catheter with Post Insertion
More informationCentral Venous Access Devices. Stephanie Cunningham Amy Waters
Central Venous Access Devices Stephanie Cunningham Amy Waters 5 Must Know Facts About CVAD s 1) What are CVAD s? 2) What are CVAD s used for? 3) How are these devices put in? 4) What are the complications
More informationPeripherally Inserted Central Catheter & Midline Placement with ECG Confirmation of Tip Placement
Title/Description: Peripherally Inserted Central Catheter & Midline Placement with ECG Confirmation of Tip Placement Department: Patient Care Services Personnel: Nursing Services Effective Date: April
More informationLines and tubes. 1 Nasogastric tubes Endotracheal tubes Central lines Permanent pacemakers Chest drains...
Lines and tubes 1 Nasogastric tubes... 15 2 Endotracheal tubes.... 19 3 Central lines... 21 4 Permanent pacemakers.... 25 5 Chest drains... 30 This page intentionally left blank 1 Nasogastric tubes Background
More informationCardiovascular System Notes: Physiology of the Heart
Cardiovascular System Notes: Physiology of the Heart Interesting Heart Fact Capillaries are so small it takes ten of them to equal the thickness of a human hair. Review What are the 3 parts of the cardiovascular
More informationLarge veins of the thorax Brachiocephalic veins
Large veins of the thorax Brachiocephalic veins Right brachiocephalic vein: formed at the root of the neck by the union of the right subclavian & the right internal jugular veins. Left brachiocephalic
More informationOverview of CVADs. Type of device commonly used. Dwell time Flushing requirement Associated complications. lumens
Source: Clinical Skills Management of Vascular Access Devices Pre-course handbook. Adapted with permission from NHS Lothian Employee and Education Development Team. Overview of CVADs Type of device Veins
More informationCase #1. Case #1- Possible codes. Unraveling the -59 modifier. Principles of Interventional. CASE 1: Simple angioplasty
Unraveling the -59 modifier Principles of Interventional Coding Donald Schon, MD, FACP Debra Lawson, CPC, PCS Distinct or independent from other services performed on the same day Normally not reported
More informationExternal Jugular Vein Catheterization Using Intra-Atrial Electrocardiogram
Original Article DOI 10.3349/ymj.2009.50.2.222 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 50(2):222-226, 2009 External Jugular Vein Catheterization Using Intra-Atrial Electrocardiogram Dilek Karaaslan,
More informationMatters of the Heart: Comprehensive Cardiology SARAH BEANLANDS RN BSCN MSC
Matters of the Heart: Comprehensive Cardiology SARAH BEANLANDS RN BSCN MSC Who am I? Class Outline Gross anatomy of the heart Trip around the heart Micro anatomy: cellular and tissue level Introduction
More informationCARDIOVASCULAR SYSTEM
CARDIOVASCULAR SYSTEM Overview Heart and Vessels 2 Major Divisions Pulmonary Circuit Systemic Circuit Closed and Continuous Loop Location Aorta Superior vena cava Right lung Pulmonary trunk Base of heart
More informationThe Mammalian Circulatory System
The Mammalian Heart The Mammalian Circulatory System Recall: What are the 3 cycles of the mammalian circulatory system? What are their functions? What are the three main vessel types in the mammalian circulatory
More informationCATCH A WAVE.. INTRODUCTION NONINVASIVE HEMODYNAMIC MONITORING 4/12/2018
WAVES CATCH A WAVE.. W I S C O N S I N P A R A M E D I C S E M I N A R A P R I L 2 0 1 8 K E R I W Y D N E R K R A U S E R N, C C R N, E M T - P Have you considered that if you don't make waves, nobody
More informationSWISS SOCIETY OF NEONATOLOGY. Potentially fatal complications of peripherally inserted central venous catheters (PICCs)
SWISS SOCIETY OF NEONATOLOGY Potentially fatal complications of peripherally inserted central venous catheters (PICCs) October 2001 2 Berger TM, Neonatal and Pediatric Intensive Care Unit, Children s Hospital
More informationUpper Extremity Venous Duplex. Michigan Sonographers Society Fall Ultrasound Symposium October 15, 2016
Upper Extremity Venous Duplex Michigan Sonographers Society Fall Ultrasound Symposium October 15, 2016 Patricia A. (Tish) Poe, BA RVT FSVU Director of Quality Assurance Navix Diagnostix Patricia A. Poe
More informationAbout atrial fibrillation (AFib) Atrial Fibrillation (AFib) What is AFib? What s the danger? Who gets AFib?
Understanding AFib Atrial Fibrillation (AFib) About AFib 3 How Your Heart Works 4 Types of AFib 5 Symptoms 5 Risk Factors 5 How is AFib Diagnosed? 6 Treatment 6 What to Ask Your Doctor 7 A normal heartbeat
More informationCARDIOVASCULAR SYSTEM Worksheet
CARDIOVASCULAR SYSTEM Worksheet NAME Section A: Blood Basics http://www.psbc.org/hematology/01_index.htm Although blood appears to be red liquid it is actually composed of yellowish liquid called plasma
More informationIdentification and Management of Central Vascular Access Device Complications
Identification and Management of Central Vascular Access Device Complications David Hahn, MD Interventional Radiology NorthShore University HealthSystem Evanston, Illinois Disclosures Consultant, AngioDynamics,
More informationIV therapy. By: Susan Mberenga, RN, MSN. Copyright 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
IV therapy By: Susan Mberenga, RN, MSN 1 IV Therapy Types of solutions Isotonic Hypotonic Hypertonic Caution: Too rapid or excessive infusion of any IV fluid has the potential to cause serious problems
More informationUltrasound Guided Vascular Access. 7/25/2016
Ultrasound Guided Vascular Access 7/25/2016 www.ezono.com 1 Objectives Indications for insertion of central and peripheral lines Complications associated with procedures Role of ultrasound in vascular
More informationAdult Echocardiography Examination Content Outline
Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,
More information2.02 Understand the functions and disorders of the circulatory system
2.02 Understand the functions and disorders of the circulatory system 2.02 Understand the functions and disorders of the circulatory system Essential questions: What are the functions of blood? What are
More informationAppendix E: Overview of Vascular
Appendix E: Overview of Vascular 56 Peripheral Short Catheter, less than 3 inches (7.5 cm) in length; over-the-needle catheter is most common. Inserted by percutaneous venipuncture, generally into a hand
More informationA systematic review of the effectiveness of intra-cavitary. electrocardiographic guidance in improving CVAD tip placement
A systematic review of the effectiveness of intra-cavitary electrocardiographic guidance in improving CVAD tip placement (Walker G, Rickard CM, Alexandrou E, Webster J, Chan R. Effectiveness of electrocardiographic
More informationHealth Science 20 Circulatory System Notes
Health Science 20 Circulatory System Notes Functions of the Circulatory System The circulatory system functions mainly as the body s transport system. It transports: o Oxygen o Nutrients o Cell waste o
More informationThe Cardiovascular System. Chapter 15. Cardiovascular System FYI. Cardiology Closed systemof the heart & blood vessels. Functions
Chapter 15 Cardiovascular System FYI The heart pumps 7,000 liters (4000 gallons) of blood through the body each day The heart contracts 2.5 billion times in an avg. lifetime The heart & all blood vessels
More informationPICC Care and Maintenance. Mary Lou Chaulk, RN
PICC Care and Maintenance Mary Lou Chaulk, RN Types: Valved: Bard - Groshong - valve at distal tip -Solo - valve at proximal hub - Power PICC Angio Dynamic (Navilyst) - Vaxcel -Xcela (Power PICC) - Bioflo
More informationEKG Competency for Agency
EKG Competency for Agency Name: Date: Agency: 1. The upper chambers of the heart are known as the: a. Atria b. Ventricles c. Mitral Valve d. Aortic Valve 2. The lower chambers of the heart are known as
More informationKadlec Regional Medical Center Cardiac Electrophysiology
Definition of electrophysiology study and ablation Kadlec Regional Medical Center Cardiac Electrophysiology Electrophysiology Study and Ablation An electrophysiology, or EP, study is a test of the heart
More informationTHE HEART. A. The Pericardium - a double sac of serous membrane surrounding the heart
THE HEART I. Size and Location: A. Fist-size weighing less than a pound (250 to 350 grams). B. Located in the mediastinum between the 2 nd rib and the 5 th intercostal space. 1. Tipped to the left, resting
More informationHemodynamic Monitoring and Circulatory Assist Devices
Hemodynamic Monitoring and Circulatory Assist Devices Speaker: Jana Ogden Learning Unit 2: Hemodynamic Monitoring and Circulatory Assist Devices Hemodynamic monitoring refers to the measurement of pressure,
More informationCardiovascular System Notes: Heart Disease & Disorders
Cardiovascular System Notes: Heart Disease & Disorders Interesting Heart Facts The Electrocardiograph (ECG) was invented in 1902 by Willem Einthoven Dutch Physiologist. This test is still used to evaluate
More informationA PATIENT S GUIDE TO THE LEFT ATRIAL APPENDAGE CLOSURE. Reducing the risk of stroke in atrial fibrillation
A PATIENT S GUIDE TO THE LEFT ATRIAL APPENDAGE CLOSURE Reducing the risk of stroke in atrial fibrillation TABLE OF CONTENTS IMPORTANT Please Note: Information provided by Boston Scientific Corporation
More informationPatient Resources: Arrhythmias and Congenital Heart Disease
Patient Resources: Arrhythmias and Congenital Heart Disease Overview Arrhythmias (abnormal heart rhythms) can develop in patients with congenital heart disease (CHD) due to thickening/weakening of their
More informationTHE HEART THE CIRCULATORY SYSTEM
THE HEART THE CIRCULATORY SYSTEM There are three primary closed cycles: 1) Cardiac circulation pathway of blood within the heart 2) Pulmonary circulation blood from the heart to lungs and back 3) Systemic
More informationThe HeRO Graft. Shawn M. Gage, PA Division of Vascular Surgery Duke University Medical Center
The HeRO Graft Shawn M. Gage, PA Division of Vascular Surgery Duke University Medical Center Faculty Disclosure I disclose the following financial relationships: CryoLife/Hemosphere, Inc. & W.L. Gore and
More informationThe Heart and Cardiovascular System
The Heart and Cardiovascular System What you will learn The location of the heart 3 layers and covering of the heart Explain the function of the heart as 2 separate pumps Identify the 4 chambers of the
More informationCateteri venosi per emodialisi nel 2017: lo stato dell arte Maurizio Gallieni
Cateteri venosi per emodialisi nel 2017: lo stato dell arte Maurizio Gallieni Nephrology and Dialysis Unit Ospedale S. Carlo Borromeo, ASST Santi Paolo e Carlo, University of Milano, Milano, Italy Kidney
More informationHemodialysis catheters - from placement to complications: Our experience
Hemodialysis catheters - from placement to complications: Our experience Poster No.: C-2048 Congress: ECR 2010 Type: Scientific Exhibit Topic: Interventional Radiology - Vascular Authors: E. T. H. Liu,
More informationInteresting Cases - A Case Report: Renal Cell Carcinoma With Tumor Mass In IVC And Heart. O Wenker, L Chaloupka, R Joswiak, D Thakar, C Wood, G Walsh
ISPUB.COM The Internet Journal of Thoracic and Cardiovascular Surgery Volume 3 Number 2 Interesting Cases - A Case Report: Renal Cell Carcinoma With Tumor Mass In IVC And Heart O Wenker, L Chaloupka, R
More informationHeart Disorders. Cardiovascular Disorders (Part B-1) Module 5 -Chapter 8. Overview Heart Disorders Vascular Disorders
Cardiovascular Disorders (Part B-1) Module 5 -Chapter 8 Overview Heart Disorders Vascular Disorders Susie Turner, MD 1/7/13 Heart Disorders Coronary Artery Disease Cardiac Arrhythmias Congestive Heart
More informationThe Impact of Catheter Occlusion in Central Line Associated Bloodstream Infections M A R C H 15, 2017
The Impact of Catheter Occlusion in Central Line Associated Bloodstream Infections D A R C Y DOELLMAN M S N, RN, CRNI, VA - BC M A R C H 15, 2017 LOUISVILLE, KENTUCKY Cincinnati Children s Hospital 642
More informationMr. Epithelium s Anatomy and Physiology Test SSSS
Mr. Epithelium s Anatomy and Physiology Test SSSS You have 50 minutes to complete this test packet. One 8.5 x 11 cheat sheet is allowed, along with 1 non-programmable calculator dedicated to computation.
More informationSIKLUS JANTUNG. Rahmatina B. Herman
SIKLUS JANTUNG Rahmatina B. Herman The Cardiac Cycle Definition: The cardiac events that occur from the beginning of one heartbeat to the beginning of the next The cardiac cycle consists of: - Diastole
More informationUse of EKOS Catheter in the management of Venous Mr. Manoj Niverthi, Mr. Sarang Pujari, and Ms. Nupur Dandavate, The GTF Group
Use of EKOS Catheter in the management of Venous Thromboembolism @ Mr. Manoj Niverthi, Mr. Sarang Pujari, and Ms. Nupur Dandavate, The GTF Group Introduction Georgia Thrombosis Forum (GTF, www.gtfonline.net)
More informationTechnical option of surgical approach for trouble-shooting
JHRS Corner Device and lead trouble-shooting - standard strategy and technical option - Technical option of surgical approach for trouble-shooting Katsuhiko IMAI Department of Cardiovascular surgery, Hiroshima
More informationAdvocate Christ Medical Center CVC Placement Certification Course
Advocate Christ Medical Center CVC Placement Certification Course July 12th, 2012 Hannah Watts, MD Medical Simulation Director Modified August 10, 2017 Taajwar Khan, MD Chief Resident of Internal Medicine
More informationDouble Superior Vena Cava; A Benign Cause of Widened Mediastenum and Implication on Venous Central Access
ISPUB.COM The Internet Journal of Endovascular Medicine Volume 2 Number 1 Double Superior Vena Cava; A Benign Cause of Widened Mediastenum and Implication on Venous H Enuh, A Patel, A Chaudry, K Diaz,
More informationParoxysmal Supraventricular Tachycardia PSVT.
Atrial Tachycardia; is the name for an arrhythmia caused by a disorder of the impulse generation in the atrium or the AV node. An area in the atrium sends out rapid signals, which are faster than those
More informationPrevention of thrombosis
Prevention of thrombosis Massimo Lamperti MD, MBA Chief of General Anaesthesia Department Anaesthesiology Institute Cleveland Clinic Abu Dhabi Clinical Professor of Anaesthesiology Cleveland Clinic Lerner
More informationCardiovascular System
Cardiovascular System The Heart Cardiovascular System The Heart Overview What does the heart do? By timed muscular contractions creates pressure gradients blood moves then from high pressure to low pressure
More informationHow to Approach the Patient with CRT and Recurrent Heart Failure
How to Approach the Patient with CRT and Recurrent Heart Failure Byron K. Lee MD Associate Professor of Medicine Electrophysiology and Arrhythmia Section UCSF Update in Electrocardiography and Arrhythmias
More information4. The two inferior chambers of the heart are known as the atria. the superior and inferior vena cava, which empty into the left atrium.
Answer each statement true or false. If the statement is false, change the underlined word to make it true. 1. The heart is located approximately between the second and fifth ribs and posterior to the
More informationChapter 14. Circulatory System Images. VT-122 Anatomy & Physiology II
Chapter 14 Circulatory System Images VT-122 Anatomy & Physiology II The mediastinum Dog heart Dog heart Cat heart Dog heart ultrasound Can see pericardium as distinct bright line Pericardial effusion Fluid
More informationPercutaneously Inserted AngioVac Suction Thrombectomy for the Treatment of Filter-Related. Iliocaval Thrombosis
Percutaneously Inserted AngioVac Suction Thrombectomy for the Treatment of Filter-Related Iliocaval Thrombosis Faiz D. Francis, DO; Gianvito Salerno, MD; Sabbah D. Butty, MD Abstract In the setting of
More informationLecture 2: Clinical anatomy of thoracic cage and cavity II
Lecture 2: Clinical anatomy of thoracic cage and cavity II Dr. Rehan Asad At the end of this session, the student should be able to: Identify and discuss clinical anatomy of mediastinum such as its deflection,
More informationLab #3: Electrocardiogram (ECG / EKG)
Lab #3: Electrocardiogram (ECG / EKG) An introduction to the recording and analysis of cardiac activity Introduction The beating of the heart is triggered by an electrical signal from the pacemaker. The
More informationPacemaker and AV Node Ablation Patient Information
Melbourne Heart Rhythm Pacemaker and AV Node Ablation Patient Information The Heart The heart is a pump responsible for maintaining blood supply to the body. It has four chambers. The two upper chambers
More informationCatheter Ablation. Patient Education
Catheter Ablation Patient Education Allina Health System Your heart has four chambers. Two upper chambers (atria) pump blood to the two lower chambers (ventricles). In order for the heart to pump, it requires
More informationPort Design. Page 1. Port Placement, Removal, and Management. Selecting a Vascular Access Device. Thomas M. Vesely, MD
Non-Dialysis Procedures Port Placement, Removal, and Management Thomas M. Vesely, MD Saint Louis, Missouri Selecting a Vascular Access Device Duration of use Number of lumens Frequency used Blood flow
More informationCRC 431 ECG Basics. Bill Pruitt, MBA, RRT, CPFT, AE-C
CRC 431 ECG Basics Bill Pruitt, MBA, RRT, CPFT, AE-C Resources White s 5 th ed. Ch 6 Electrocardiography Einthoven s Triangle Chest leads and limb leads Egan s 10 th ed. Ch 17 Interpreting the Electrocardiogram
More informationThe Heart. Happy Friday! #takeoutyournotes #testnotgradedyet
The Heart Happy Friday! #takeoutyournotes #testnotgradedyet Introduction Cardiovascular system distributes blood Pump (heart) Distribution areas (capillaries) Heart has 4 compartments 2 receive blood (atria)
More informationElectrical Conduction
Sinoatrial (SA) node Electrical Conduction Sets the pace of the heartbeat at 70 bpm AV node (50 bpm) and Purkinje fibers (25 40 bpm) can act as pacemakers under some conditions Internodal pathway from
More informationTest Review Circulatory System Chapters
Test Review Circulatory System Chapters 13-2010 1. The tissue that forms the tight fitting sac around the heart is the a. parietal pericardium c. myocardium b. visceral pericardium d. endocardium 2. Which
More informationCRITICAL THINKING QUESTIONS AND ANSWERS AND CYCLE 2 LAB EXAM TEMPLATE. There are two main mechanisms that work in conjunction to return the blood
CRITICAL THINKING QUESTIONS AND ANSWERS AND CYCLE 2 LAB EXAM TEMPLATE There are two main mechanisms that work in conjunction to return the blood THE CARDIAC PUMP 1) The forward pull(vis a fronte) This
More informationCardiac Emergencies. Jim Bennett Paramedic and Clinical Education Coordinator American Medical Response Spokane, Washington
Cardiac Emergencies Jim Bennett Paramedic and Clinical Education Coordinator American Medical Response Spokane, Washington The Heart -------Aorta Pulmonary Veins---- Superior Vena Cava------ Right Atrium-----
More informationSpontaneous Migration of a Central Line Catheter into the Heart. Saeed Al Hindi, MD, CABS, FRCSI* Khulood Al-Saad, MD**
Bahrain Medical Bulletin, Vol. 29, No. 3, September 2007 Spontaneous Migration of a Central Line Catheter into the Heart Saeed Al Hindi, MD, CABS, FRCSI* Khulood Al-Saad, MD** Background: Spontaneous migration
More informationCirculatory System Review
Circulatory System Review 1. Know the diagrams of the heart, internal and external. a) What is the pericardium? What is myocardium? What is the septum? b) Explain the 4 valves of the heart. What is their
More informationRelax and Learn At the Farm 2012
Relax and Learn At the Farm Session 9: Invasive Hemodynamic Assessment and What to Do with the Data Carol Jacobson RN, MN Cardiovascular Nursing Education Associates Function of CV system is to deliver
More informationArrhythmias. Pulmonary Artery
Arrhythmias Introduction Cardiac arrhythmia is an irregularity of the heart beat that causes the heart to beat too slowly, too fast, or irregularly. There are different types of arrhythmias. Most arrhythmias
More information10. Thick deposits of lipids on the walls of blood vessels, called, can lead to serious circulatory issues. A. aneurysm B. atherosclerosis C.
Heart Student: 1. carry blood away from the heart. A. Arteries B. Veins C. Capillaries 2. What is the leading cause of heart attack and stroke in North America? A. alcohol B. smoking C. arteriosclerosis
More informationECG. Prepared by: Dr.Fatima Daoud Reference: Guyton and Hall Textbook of Medical Physiology,12 th edition Chapters: 11,12,13
ECG Prepared by: Dr.Fatima Daoud Reference: Guyton and Hall Textbook of Medical Physiology,12 th edition Chapters: 11,12,13 The Concept When the cardiac impulse passes through the heart, electrical current
More informationIV Drug Delivery Systems used in Cancer Care
IV Drug Delivery Systems used in Cancer Care Cheri Constantino-Shor, RN, MSN, CRNI Seattle Cancer Care Alliance Nursing Staff Development Coordinator Presentation Objective Describe drug delivery devices
More informationThe Circulatory System. The Heart, Blood Vessels, Blood Types
The Circulatory System The Heart, Blood Vessels, Blood Types The Closed Circulatory System Humans have a closed circulatory system, typical of all vertebrates, in which blood is confined to vessels and
More information