DOCSLIB.ORG

The Cardiopulmonary Bypass, Hemolysis, and End Organ Function: an Integration of Political Science, Chemistry, and Zoology

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Cardiopulmonary Bypass, Hemolysis, and End Organ Function: an Integration of Political Science, Chemistry, and Zoology The Cardiopulmonary Bypass, Hemolysis, and end organ function: an Integration of Political Science, Chemistry, and Zoology By Nathan V. Luce A capstone project submitted to the faculty of Weber State University in fulfillment of the requirements of the degree of Bachelor of Integrated Studies in the Department of Integrated Studies. Ogden, Utah (Date Approved) Approved by: Department Director Dr. Michael Cena Ph.D. Committee Members: Political Science Dr. Gary Johnson Ph.D. Clinical and Clinical Research: Chemistry and Zoology Dr. Peter C. Minneci M.D. Marie Hart Clayton MSN, RN TABLE OF CONTENTS PREFACE......................................................................................................................................... v INTRODUCTION............................................................................................................................... 1 HISTORY AND BASICS: CARDIAC SURGERY AND THE CPB.................................................... 3 Evolution of Cardiac Surgery............................................................................................ 3 Intraoperative........................................................................................................... 5 Effects of Cardiopulmonary Bypass................................................................................. 6 Mechanical............................................................................................................... 6 Physiological: Whole Body Inflammatory Response................................................ 6 THE INTEGRATION OF POLITICAL SCIENCE AND THE SCIENCES.......................................... 11 The Chemistry Component................................................................................................ 11 Discovery and Physical Properties of Nitric Oxide................................................... 11 The Zoology Component.................................................................................................... 13 NOs role in vascular flow and dynamics.................................................................. 14 Physiology: Kidney, heart, Lungs, Liver................................................................... 16 Policy and Politics.............................................................................................................. 17 Experimentation without Representation: a matter of consent and privacy……….. 18 HIPAA and other Civil Rights................................................................................... 23 Institutional Review Board....................................................................................... 26 Clinical Research: a balance between science and policy...................................... 27 METHODS OF ACADEMIC INQUIRY.............................................................................................. 30 Gaining Entry into a Research Lab................................................................................... 30 The Lab’s Research Objectives and Hypothesis............................................................. 31 My Lab Responsibilities..................................................................................................... 33 Data Management……………………………………………………………………….. 34 Blood and Urine Sample Collection......................................................................... 36 Devices used for Analysis........................................................................................ 37 Statistical Considerations.................................................................................................. 39 Protecting Participants’ Rights......................................................................................... 39 RESEARCH FINDINGS.................................................................................................................... 40 Physical and Biological Sciences..................................................................................... 40 Political Science.................................................................................................................. 49 DISCUSSION.................................................................................................................................... 50 Hemolysis and NO Consumption...................................................................................... 50 Administration and Socioeconomics………………………………………………………… 54 Obedience and Morality…………………………………………………………………. 54 The Socioeconomics of Clinical Research…........................................................... 56 CONCLUSION………………………………………………………………………………………………. 60 CAPSTONE PROJECT OUTCOMES............................................................................................... 62 What I Learned in My Experience...................................................................................... 62 My Future Plans for Academic Study and Employment................................................. 62 APPENDIX A-I.................................................................................................................................. i REFERENCES.................................................................................................................................. xii i LIST OF TABLES Table 1. Physical and Chemical Properties of Nitric Oxide............................................................................... 12 Table 2. Common biochemical, physiologic, and organ function tests............................................................. 17 Table 3. Informed Consent Checklist - Basic and Additional Elements............................................................ 22 Table 4. Parameters that play important roles in privacy in healthcare............................................................ 24 Table 5. Three primary hypothesize in the study of intravascular hemolysis and NO scavenging.................. 31 Table 6. Time period, title, protocol, location and responsibilities at HUP........................................................ 33 Table 7. Times with, title, protocol, location and responsibilities at CHOP....................................................... 34 Table 8. Case Report Form and post discharge timeline…………………………………………………………... 35 Table 9. Illustration of blood, urine, PHI time points and blood volumes…………………………………………. 36 Table 10. Digital reactive hyperemia challenge using Itamar endo-PAT 2000................................................... 37 Table 11. Methods of measuring OxyHb scavenging capabilities using Sievers Nitric Oxide Analyzer 280i….. 38 Table 12. UV spectrophotometer analysis.......................................................................................................... 38 Table 13. Intraoperative Details.......................................................................................................................... 41 Table 14. Hospital Course................................................................................................................................... 41 Appendix List of Tables A. Comprehensive record of surgeon, event, year, and outcomes in the development of the CPB ….............. i E. Educational demographics: a comparison of differences between blacks and whites.................................... vi ii LIST OF FIGURES Figure 1. CPB: circuitry, pump, oxygenator, heat exchange, cardioplegia.................................................... 4 Figure 2. Aortic and Venous cannulation during Mitral valve surgery............................................................ 4 Figure 3. Effects of extracorporeal circuit on plasma……………………………………………………………... 8 Figure 4. Exposure of blood to circuit and its effects on neutrophils and end-organ tissue damage............ 8 Figure 5. Activation of immune system and effects on neutrophils, endothelium and interstitial species…... 9 Figure 6. Endothelial response to injury via leukocyte adhesion molecules and procoagulant changes....... 10 Figure 7. Sequelae of intravascular hemolysis and NO scavenging by Hb molecules................................... 32 Figure 8. Pre-Admission Participant Characteristics………………………………………................................ 42 Figure 9. Procedure Type and Frequency....................................................................................................... 42 Figure 10. Morbidity and Mortality...................................................................................................................... 43 Figure 11. Overall OxyHb and NO consumption trends…………………………………………………………… 44 Figure 12. One hour OxyHb and NO consumption trends………………………………………………………… 44 Figure 13. Three hour OxyHb and NO consumption trends………………………………………………………. 45 Figure 14. Five hour OxyHb and NO consumption trends………………………………………………………… 45 Figure 15. Nine hour OxyHb and NO consumption trend…………………………………………………………. 46 Figure 16. Total patients and deaths per hour……………………………………………………………………… 47 Figure 17. One-hour mortality trend: NO cons and OxyHb……………………………………………………….. 47 Figure 18. Five-hour mortality trend: NO cons and OxyHb……………………………………………………….. 48 Figure 19. Off pump mortality trend: NO cons and OxyHb……………………………………………………….. 48 Appendix List of Figures B. University of Pennsylvania Research Subject Informed Consent Form…................................................... ii C. University of Pennsylvania-Office of Regulatory Affairs IRB Review…......................................................
Load more

Recommended publications
  • The Incidence of Microemboli to the Brain Is Less with Endarterectomy Than with Percutaneous Revascularization with Distal filters Or flow Reversal
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector From the Southern Association for Vascular Surgery The incidence of microemboli to the brain is less with endarterectomy than with percutaneous revascularization with distal filters or flow reversal Naren Gupta, MD, PhD,a Matthew A. Corriere, MD, MS,a,c Thomas F. Dodson, MD,a Elliot L. Chaikof, MD, PhD,a Robert J. Beaulieu, BS,b James G. Reeves, MD,a Atef A. Salam, MD,a and Karthikeshwar Kasirajan, MD,a Atlanta, Ga Background: Current data suggest microembolization to the brain may result in long-term cognitive dysfunction despite the absence of immediate clinically obvious cerebrovascular events. We reviewed a series of patients treated electively with carotid endarterectomy (CEA), carotid artery stenting (CAS) with distal filters, and carotid stenting with flow reversal (FRS) monitored continuously with transcranial Doppler scan (TCD) during the procedure to detect microembolization rates. Methods: TCD insonation of the M1 segment of the middle cerebral artery was conducted during 42 procedures (15 CEA, 20 CAS, and 7 FRS) in 41 patients seen at an academic center. One patient had staged bilateral CEA. Ipsilateral microembolic signals (MESs) were divided into three phases: preprotection phase (until internal carotid artery [ICA] cross-shunted or clamped if no shunt was used, filter deployed, or flow reversal established), protection phase (until clamp/shunt was removed, filter removed, or antegrade flow re-established), and postprotection phase (after clamp/ shunt was removed, filter removed, or antegrade flow re-established). Descriptive statistics are reported as mean ؎ SE for continuous variables and N (%) for categorical variables.
    [Show full text]
  • Research Article Endothelial Dysfunction of Patients with Peripheral Arterial Disease Measured by Peripheral Arterial Tonometry
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Crossref Hindawi Publishing Corporation International Journal of Vascular Medicine Volume 2016, Article ID 3805380, 6 pages http://dx.doi.org/10.1155/2016/3805380 Research Article Endothelial Dysfunction of Patients with Peripheral Arterial Disease Measured by Peripheral Arterial Tonometry Kimihiro Igari, Toshifumi Kudo, Takahiro Toyofuku, and Yoshinori Inoue Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan Correspondence should be addressed to Kimihiro Igari; igari.srg1@tmd.ac.jp Received 16 July 2016; Revised 17 September 2016; Accepted 27 September 2016 Academic Editor: Thomas Schmitz-Rixen Copyright © 2016 Kimihiro Igari et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. Endothelial dysfunction plays a key role in atherosclerotic disease. Several methods have been reported to be useful for evaluating the endothelial dysfunction, and we investigated the endothelial dysfunction in patients with peripheral arterial disease (PAD) using peripheral arterial tonometry (PAT) test in this study. Furthermore, we examined the factors significantly correlated with PAT test. Methods. We performed PAT tests in 67 patients with PAD. In addition, we recorded the patients’ demographics, including comorbidities, and hemodynamical status, such as ankle brachial pressure index (ABI). Results. In a univariate analysis, the ABI value ( = 0.271, = 0.029) and a history of cerebrovascular disease ( = 0.208, = 0.143) were found to significantly correlatewithPATtest,whichcalculatedthereactivehyperemiaindex(RHI).Inamultivariateanalysis,onlytheABIvalue significantly and independently correlated with RHI ( = 0.254, = 0.041).
    [Show full text]
  • New York State Surgical and Invasive Procedure Protocol (NYSSIPP)
    State of New York Department of Health Office of Health Systems Management Division of Primary and Acute Care Services New York State Surgical and Invasive Procedure Protocol for Hospitals ~ Diagnostic and Treatment Centers Ambulatory Surgery Centers ~ Individual Practitioners Antonia C. Novello, M.D., M.P.H., Dr.P.H. Commissioner of Health Hon. George E. Pataki Governor – State of New York September 2006 Surgical and Invasive Procedure Protocol September 2006 NEW YORK STATE SURGICAL AND INVASIVE PROCEDURE PROTOCOL (FOR THE PREVENTION OF WRONG PATIENT, WRONG SITE, WRONG SIDE & WRONG INVASIVE PROCEDURE EVENTS) I. STATEMENT OF PURPOSE The State of New York is committed to providing its residents access to quality health care. Hon. George E. Pataki, Governor and Antonia C. Novello M.D., M.P.H., Dr.P.H., Commissioner of Health, continue to work toward a system that reduces medical and surgical errors by commitment to a safe and protected patient care environment. Key to achieving this goal is promoting a culture of safety and strengthening open communication among health care providers, individual practitioners and the patients they serve. One of the goals of Governor Pataki and Commissioner Novello, is the elimination of wrong patient, wrong site, wrong side and wrong invasive procedures, through the development of comprehensive systems that ensure the correct procedure is done on the correct patient on the correct site. Increased practitioner awareness combined with strong provider protocols and standardization will enhance the patient safety measures currently in place. The New York State Surgical and Invasive Procedure Protocol (NYSSIPP) developed by the Procedural and Surgical Site Verification Panel (PSSVP) is intended for all patient care settings and for all individual practitioners.
    [Show full text]
  • Fluorescein Angiography: Preventing and Responding to Complications
    Fluorescein Angiography: Preventing and Responding to Complications Jacqueline G. Jaffee, J.D. OMIC Risk Management Specialist PURPOSE OF RISK MANAGEMENT RECOMMENDATIONS OMIC regularly analyzes its claims experience to determine loss prevention measures that our insured ophthalmologists can take to reduce the likelihood of professional liability lawsuits. OMIC policyholders are not required to implement these risk management recommendations. Use your professional judgment in determining the applicability of a given recommendation to their particular patients and practice situation. These loss prevention documents may refer to clinical care guidelines such as the American Academy of Ophthalmology’s Preferred Practice Patterns, peer-reviewed articles, or to federal or state laws and regulations. However, our risk management recommendations do not constitute the standard of care nor do they provide legal advice. If legal advice is desired or needed, consult an attorney. Information contained here is not intended to be a modification of the terms and conditions of the OMIC professional and limited office premises liability insurance policy. Please refer to the OMIC policy for these terms and conditions. Version 1/24/08 Fluorescein angiography (FA) is a diagnostic procedure in which a rapid sequence of photographs is taken to document the blood circulation of the retina/choroid. The dye is usually injected into a vein in the arm, forearm, or hand. While generally well tolerated, angiography is an invasive procedure with associated risks, very rarely but notably of a life-threatening allergic reaction. The following risk management recommendations have been compiled to assist you and your staff so that you may both prevent and better respond to the risks of the procedure.
    [Show full text]
  • Coders' Desk Reference for ICD-10-PCS Procedures
    2 0 2 DESK REFERENCE 1 ICD-10-PCS Procedures ICD-10-PCS for DeskCoders’ Reference Coders’ Desk Reference for ICD-10-PCS Procedures Clinical descriptions with answers to your toughest ICD-10-PCS coding questions Sample 2021 optum360coding.com Contents Illustrations ..................................................................................................................................... xi Introduction .....................................................................................................................................1 ICD-10-PCS Overview ...........................................................................................................................................................1 How to Use Coders’ Desk Reference for ICD-10-PCS Procedures ...................................................................................2 Format ......................................................................................................................................................................................3 ICD-10-PCS Official Guidelines for Coding and Reporting 2020 .........................................................7 Conventions ...........................................................................................................................................................................7 Medical and Surgical Section Guidelines (section 0) ....................................................................................................8 Obstetric Section Guidelines (section
    [Show full text]
  • ICD-9-CM Procedures (FY10)
    2 PREFACE This sixth edition of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is being published by the United States Government in recognition of its responsibility to promulgate this classification throughout the United States for morbidity coding. The International Classification of Diseases, 9th Revision, published by the World Health Organization (WHO) is the foundation of the ICD-9-CM and continues to be the classification employed in cause-of-death coding in the United States. The ICD-9-CM is completely comparable with the ICD-9. The WHO Collaborating Center for Classification of Diseases in North America serves as liaison between the international obligations for comparable classifications and the national health data needs of the United States. The ICD-9-CM is recommended for use in all clinical settings but is required for reporting diagnoses and diseases to all U.S. Public Health Service and the Centers for Medicare & Medicaid Services (formerly the Health Care Financing Administration) programs. Guidance in the use of this classification can be found in the section "Guidance in the Use of ICD-9-CM." ICD-9-CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Centers for Medicare & Medicaid Services are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9- CM is the responsibility of the Federal Government. However, because the ICD-9-CM represents the best in contemporary thinking of clinicians, nosologists, epidemiologists, and statisticians from both public and private sectors, no future modifications will be considered without extensive advice from the appropriate representatives of all major users.
    [Show full text]
  • Anti-Apolipoprotein A-1 Igg Influences Neutrophil Extracellular Trap
    International Journal of Molecular Sciences Article Anti-Apolipoprotein A-1 IgG Influences Neutrophil Extracellular Trap Content at Distinct Regions of Human Carotid Plaques Rafaela F. da Silva 1,2 , Daniela Baptista 1, Aline Roth 1, Kapka Miteva 1 , Fabienne Burger 1, Nicolas Vuilleumier 3,4, Federico Carbone 5,6 , Fabrizio Montecucco 5,6 , François Mach 1 and Karim J. Brandt 1,* 1 Division of Cardiology, Foundation for Medical Researches, Department of Medicine Specialties, Faculty of Medicine, University of Geneva, Av. de la Roseraie 64, 1211 Geneva, Switzerland; rfdasilva.ufmg@gmail.com (R.F.d.S.); daniela.baptista@unige.ch (D.B.); aline.roth@unige.ch (A.R.); kapka.miteva@unige.ch (K.M.); fabienne.burger@unige.ch (F.B.); francois.mach@unige.ch (F.M.) 2 Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, 31270-901 Belo Horizonte, Brazil 3 Department of Diagnostics, Division of Laboratory Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; nicolas.vuilleumier@hcuge.ch 4 Department of Medical Specialities, Division of Laboratory Medicine, Faculty of Medicine, 1211 Geneva, Switzerland 5 First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, viale Benedetto XV n6, 16132 Genoa, Italy; federico.carbone@edu.unige.it (F.C.); fabrizio.montecucco@unige.it (F.M.) 6 IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Largo Rosanna Benzi n10, 16132 Genoa, Italy * Correspondence: Karim.brandt@hcuge.ch; Tel.: +41-2237-94-647 Received: 9 September 2020; Accepted: 13 October 2020; Published: 19 October 2020 Abstract: Background: Neutrophils accumulate in atherosclerotic plaques. Neutrophil extracellular traps (NET) were recently identified in experimental atherosclerosis and in complex human lesions.
    [Show full text]
  • Percutaneous Balloon Mitral Valvulotomy with Transesophageal Echocardiographic Monitoring: Experience in Khon Kaen University
    Percutaneous Balloon Mitral Valvulotomy with Transesophageal Echocardiographic Monitoring: Experience in Khon Kaen University SONGSAK KIATCHOOSAKUN, M.D.*, SONGKWAN SILARUKS, M.D.*, PYATAT TATSANAVIVAT,M.D.*, VIRAT KLUNGBOONKRONG, M.D.*, SUDA TANSUPHASA WADIKUL, M.D.** Abstract To study the results and complications of Percutaneous Balloon Mitral Valvulotomy with Transesophageal Echocardiographic monitoring in patients with symptomatic mitral stenosis. From November 1996 to November 1998, PBMV with TEE monitoring was performed in 107 patients with symptomatic mitral stenosis. There were 72 females and 35 males, aged 19 to 65 years (mean 37 .63). The mitral valve was successfully dilated in 104 patients. Immediately after PBMV, there was significant reduction of mean mitral valve gradient (17.89 ± 6.7 mm Hg to 6.21 ± 3.02 mm Hg), mean left atrial pressure (26.67 ± 6.61 mm Hg to 13.97 ± 4.7 mm Hg), mean pulmonary artery pressure (35.21 ± 13.03 mm Hg to 27.71 ± 10.31 mm Hg). Mitral valve area was increased from 0.80 ± 0.24 cm2 to 1.75 ± 0.42 cm2 and cardiac output was increased from 3.84 ± 0.97 Llmin to 4.74 ± 1.09 Llmin. Mitral regurgitation was detected in 20 patients, severe mitral regurgitaion appeared in one patient. None of these patients required emergency surgery. Cardiac tamponade was detected in one case and resolved by pericardiocentesis. TEE was well tolerated and no complications of TEE were detected. PBMV aided by TEE is safe and well tolerated. Key word : Transesophageal Echocardiography, Percutaneous Balloon Mitral Valvulotomy, Khon Kaen University KIATCHOOSAKUN S, SILARUKS S, TATSANAVIVAT P, KLUNGBOONKRONG V, TANSUPHASAWADIKUL S J MED Assoc Thai 2000; 83: 1486-1491 Percutaneous Balloon Mitral Valvulotomy The serious complications of this procedure are (PBMV) is a well established method of treating cardiac perforation during interatrial septal puncture symptomatic mitral valve stenosis patients0-4).
    [Show full text]
  • Updates in Minimally Invasive Cardiac Surgery for General Surgeons
    Updates in Minimally Invasive Cardiac Surgery for General Surgeons a b, Muhammad Habib Zubair, MD , John Michael Smith, MD * KEYWORDS Minimally invasive cardiac surgery Atrial septal defect Coronary artery bypass graft Mitral valve Robot KEY POINTS Significant improvement and development have occurred in minimally invasive cardiac surgery over the past 20 years. Although most studies have consistently demonstrated equivalent or improved outcomes compared with conventional cardiac surgery, with significantly shorter recovery times, adoption continues to be limited. In addition, cost data have been inconsistent. Further ongoing trials are needed to help determine the exact roles for these innovative procedures. HISTORY OF MINIMALLY INVASIVE CARDIAC SURGERY The era of minimally invasive mitral valve (MV) surgery began in 1948 when Harken and Ellis1 first described mitral valvulotomy through an intercostal approach. In 1994, Ben- etti and Ballester2 from Argentina first described the left internal mammary artery (LIMA) to left anterior descending artery (LAD) anastomosis through a small left antero- lateral thoracotomy; this was the first description of minimally invasive direct coronary artery bypass (MIDCAB) and was followed by Subramanian3 in the United States in 1996. Cosgrove and Sabik4 first described minimally invasive cardiac procedures in the United States in 1996 for the aortic valve (AV) followed by the MV.5 Stevens and colleagues6 invented the heart port platform in 1996, which opened the door to mini- mally invasive endoaortic cardiopulmonary bypass (CPB). Carpentier and colleagues7 in 1996 did the first right minithoracotomy for a mitral valve replacement (MVR) fol- lowed shortly thereafter with the first robotic-assisted mitral valve procedure. Conflicts of Interests: Consultant for Edwards Lifesciences, Intuitive Surgical, and AtriCure.
    [Show full text]
  • Cervical Epidural Anaesthesia for Carotid Artery Surgery
    353 Cervical epidural Francis Bonnet MD,* Jean Paul Derosier MD,'i" anaesthesia for carotid Frederic Pluskwa MD,* Kou Abhay MD,* A. Gaillard MDt artery surgery A series of 394 patients (251 men, 143 women; mean age 70.0 +- C2 d D4-D8 a ainsi dtd obtenu. Les patients sont restds dveillds 8.4 yr) selected for carotid artery" surgery, (CAS) performed pendant la durde de l'acte opdratoire dans des conditions de under cervical epidural anaesthesia (CEA ) was analysed retro- confort acceptables. Les complications sdrieuses rencontrdes spectively. Carotid endarterectomy was performed in 326 ont dtd la survenue d'une brdche duremdrienne dans deux cas, patients and saphenous vein bypass in 68. The cervical epidural d'une brdche vasculaire dans six cas et d'une insuffisance administration of 15 ml 0.5 per cent bupivacaine or 0.37-0.40 respiratoire chez trois patients. Hypotension (10,9 pour cent et per cent bupivacaine plus fentanyl (50-100 Izg) resulted in an bradycardie (2,8 pour cent) dtaient les effets secondaires les effective sensory blockade from C2 to T4-Ts. Patients were plus frdquemment observds. Un accident neurologique transi- maintained awake during the surgical procedure in comfortable toire s'est produit chez 84 patients pendant I'intervention condition. Serious complications included dural puncture in two chirugicale. Un accident neurologique irrdversible est survenu patients, epidural venipuncture in six patients and respiratory chez 12 patients. Trois infarctus du myocarde ont dtE diagnos- muscle paralysis in three patients. Hypotension (10.9 per cent) tiquds dans les suites opdratoires. La mortalitE de cette sdrie and bradycardia (2.8 per cent) were the most frequent side- Eta# de 2,3 pour cent.
    [Show full text]
  • Reviewing Approaches to Blood Draws
    Reviewing Approaches to Blood Draws Pitou Devgon, MD 700-0015 Rev A © 2018 Introduction & Disclosures Pitou Devgon,MD,MBA • Chief Medical Officer, Co-Founder & PIVO Inventor • MICU Hospitalist Physician, Philadelphia VA Medical Center • Association of Vascular Access (AVA) Foundation Board Member * Employee, shareholder and board member of Velano Vascular, Inc. © 2018 Tonight’s Agenda 1. Suboptimal Blood Collection Practices 2. Hurdles of PIV Blood Aspiration 3. Vascular Anatomy and the Role in Access © 2018 A Ubiquitous Yet Suboptimal Procedure 1.6 – 2.2X Average daily draws 28% Adults, 43% Peds > 1 stick attempt ~450M 15-25% CONDUCTED EVERY YEAR 88% Nurses 3+ Draws Daily IN U.S. HOSPITALS (INPATIENT) Say sticks / re-sticks impact patient experience © 2018 * Internal Data on File Venous Depletion: Setting the Stage • Definition Attempt: Loss of suitable veins for cannulation, IV therapy or dialysis due to damage from existing or past VADs or venipuncture • Venous depletion, vein wasting and vein preservation are concepts gaining attention as a means to increase appropriate use of peripheral veins and reduce the need for central vascular access devices (CVADs) • Lynn Hadaway. Infusion Teams in Acute Care Hospitals. JIN. 2013 • Last few decades frequency & intensity of venous cannulations & venipunctures for hospitalized patients increased dramatically Category Volume Driving Factors: • PVD PIV 310,000,000 • • Previous vein injury Limitations on limbs by mastectomy, stroke or contractures CVC 5,000,000 • Phlebitis • Blood clots • Infiltrations • Hematomas • Hx of IV drug use PICC 2,000,000 • Use of certain medications • Prolonged bedrest (pH low/high) • Major surgery Midline ~400,000 • Hx of multiple venous • Obesity • Smoking Venipuncture ~400,000,000 cannulations • Some Cancers (Inpatient) © 2018 Pervasive Cannulations of Vessels Vascular Access Devices (VADs) are Ubiquitous DVA Population .
    [Show full text]
  • Vascular Access Devices
    VASCULAR ACCESS DEVICES Andrea Lemmo RN, BSN VA-BC Assistant Nurse Manager Vascular Access Team Sutter Medical Center Sacramento Vascular Access Practice Criteria Preserving venous access is essential Establishing and maintaining appropriate reliable access is vital Appropriate device selection and vascular access planning prevents intravenous related problems and complications for the patient Collaborative process among the inter-professional team Vascular Access Practice Standards Device Selection Collaborative process among the inter-professional team Accommodates the vascular access needs Prescribed therapy/treatment Duration of therapy Vascular characteristics Patient comorbidities Smallest diameter device, fewest lumens, least invasive 2 Types of Vascular Access Devices PERIPHERAL IV CENTRAL VENOUS ACCESS DEVICE Short catheters (less than 3 inches) Placed in IJ, subclavian, femoral Placed in the veins of the upper Long catheter whose tip extremities terminates in a great vessel Used for therapy less than 6 days in duration 3 Types of CVAD’s Contraindicated for use with Non-tunneled Continuous vesicants Tunneled Parenteral nutrition Implanted Infusates >900 mOsmL Midline Peripheral IV (PIV) Short catheters generally placed in forearm, hand, scalp vein and lower extremity Short term therapy (less than 6 days) when infusate is non-irritating Peripheral Sites Veins of the Forearm 1. Cephalic vein 2. Median Cubital vein 3. Accessory Cephalic vein 4. Basilic vein 5. Cephalic vein 6. Median antebrachial vein Peripheral
    [Show full text]