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Figure c17/c17f001
Figure 17.1
(a) Superficial veins of the forearm. (b) Superficial veins of the dorsal aspect of the hand. (c) Central veins and veins of the upper arm.
Figure c17/c17f005
Figure 17.5
Chest X‐ray showing catheter tip correctly positioned (arrow).
Figure c17/c17f009
Figure 17.9
Vessel Health Preservation (VHP) framework. Source : Reproduced from Hallam et al. ( ) with permission of Sage Publications.
Figure c17/c17f013
Figure 17.13
Ported cannula.
Figure c17/c17f017
Figure 17.17
Visual Infusion Phlebitis (VIP) scale. Source : Reproduced from Jackson ( ) with permission of Nursing Times .
Figure c17/c17f021a
Figure 17.21
Documentation example from The Royal Marsden NHS Foundation Trust's vascular access device documentation booklet. Source : Reproduced with permission...
Figure c17/c17f025
Figure 17.25
PICC Zone Insertion Method (ZIM). Source : Reproduced from Dawson ( ) with permission of Elsevier.
Figure c17/c17f029a
Figure 17.29
Example peripherally inserted central catheter (PICC) consent form.
Figure c17/c17f033
Figure 17.33
Algorithm for the removal of a peripherally inserted central catheter (PICC). Source : Adapted from Hughes ( ).
Figure c17/c17f037
Figure 17.37
StatLock securement device.
Figure c17/c17f041
Figure 17.41
Implanted ports.
Figure c17/c17uf002
Figure 12
Turn the tap to close off the pre‐filled syringe and open it to the empty syringe.
Figure c17/c17uf006
Figure 19
Checking the needle tip.
Figure c17/c17uf010
Figure 28
Disposing of the stylet into a sharps bin.
Figure c17/c17uf014
Figure 10
Apply gel to the area and, using the ultrasound probe, assess and select the vein.
Figure c17/c17uf018
Figure 24
Flashback into the cannula chamber when the vein is punctured.
Figure c17/c17uf022
Figure 35
Semi‐permeable transparent IV film dressing.
Figure c17/c17uf026
Figure 24
Advancing the introducer.
Figure c17/c17uf030
Figure 31
Advancing the introducer.
Figure c17/c17uf034
Figure 20
Positioning, securing and labelling the cannula.
Figure c17/c17f002
Figure 17.2
The main veins used for central venous access device placement. Source : Reproduced from Dougherty ( ) with permission of John Wiley & Sons.
Figure c17/c17f006
Figure 17.6
Electrocardiogram (ECG) pattern indicating raised P waves.
Figure c17/c17f010
Figure 17.10
Patient information booklet on central venous access devices.
Figure c17/c17f014
Figure 17.14
Safety non‐ported cannula.
Figure c17/c17f018
Figure 17.18
Cleaning the skin.
Figure c17/c17f022
Figure 17.22
Applying an ultrasound probe to the arm to locate veins.
Figure c17/c17f026
Figure 17.26
Anterior view of the superficial veins.
Figure c17/c17f030
Figure 17.30
Peripherally inserted central catheter (PICC) types.
Figure c17/c17f034
Figure 17.34
Non‐tunnelled multilumen central venous catheter.
Figure c17/c17f038
Figure 17.38
Tunnelled catheter. (a) Anatomical positioning of tunnelled catheter. (b) Patient with tunnelled catheter in situ .
Figure c17/c17f042
Figure 17.42
Non‐coring needles have the penetration style of a knife so when the needle is removed, the septum closes behind it.
Figure c17/c17uf003
Figure 14
Unblocking an occluded catheter. (a) Aspirate on an empty syringe, which creates negative pressure. (b) Turn the tap to close off the empty syringe an...
Figure c17/c17uf007
Figure 21
Inserting the cannula and waiting for first flashback. (a) Open cannula. (b) Integrated closed system cannula.
Figure c17/c17uf011
Figure 29
Flushing the cannula. (a) Open cannula. (b) Integrated closed system cannula.
Figure c17/c17uf015
Figure 19
Using aseptic non‐touch technique, apply sterile gel to the transducer on the ultrasound probe and cover it with a sterile semi‐permeable transparent ...
Figure c17/c17uf019
Figure 25
Ultrasound image of the cannula inside the vein.
Figure c17/c17uf023
Figure 18
Wire being threaded in the cannula.
Figure c17/c17uf027
Figure 25
Wire being threaded in the cannula.
Figure c17/c17uf031
Figure 44
Attaching the securing device to the skin. Source : Reproduced with permission of Interrad Medical, Inc.
Figure c17/c17f003
Figure 17.3
Clot formations. Source : Reproduced from Macklin and Chernecky ( ) with permission of Elsevier.
Figure c17/c17f007
Figure 17.7
SecurAcath securing device. Source : Reproduced with permission of Interrad Medical, Inc.
Figure c17/c17f011
Figure 17.11
(a) Vein visualization device. (b) Vascular access ultrasound scanner.
Figure c17/c17f015
Figure 17.15
Safety integrated closed system.
Figure c17/c17f019
Figure 17.19
Peripheral cannula secured with StatLock.
Figure c17/c17f023
Figure 17.23
Ultrasound images of veins on screen.
Figure c17/c17f027
Figure 17.27
Anteromedial view of the superficial veins of the arm and forearm. Source : Reproduced from Tortora and Derrickson ( ) with permission of John Wiley ...
Figure c17/c17f031
Figure 17.31
Peripherally inserted central catheter (PICC) with adhesive securing device.
Figure c17/c17f035
Figure 17.35
Types of catheter tip. (a) Open‐ended catheter (single and double lumen). (b) Staggered‐exit open‐ended catheter.
Figure c17/c17f039
Figure 17.39
Groshong two‐way valve catheter. (a) Infusion (positive pressure). (b) Aspiration (negative pressure). (c) Closed (neutral pressure).
Figure c17/c17f043
Figure 17.43
Normal arterial trace.
Figure c17/c17uf004
Figure 10
Palpating the vein.
Figure c17/c17uf008
Figure 24
Second flashback. (a) Open cannula. (b) Integrated closed system cannula.
Figure c17/c17uf012
Figure 30
Method of taping a peripheral cannula.
Figure c17/c17uf016
Figure 21
Apply sterile gel and using the non‐dominant hand position the ultrasound probe 0.5–1.0 cm above the proposed site of insertion.
Figure c17/c17uf020
Figure 26
Withdraw the stylet while advancing the rest of the cannula.
Figure c17/c17uf024
Figure 21
Local anaesthetic injection.
Figure c17/c17uf028
Figure 28
Local anaesthetic injection.
Figure c17/c17uf032
Figure 8
Removing the SecurAcath device. Source : Reproduced with permission of Interrad Medical, Inc.
Figure c17/c17f004a
Figure 17.4
(a) Algorithm for partial withdrawal occlusion – that is, fluids can be infused freely by gravity but blood cannot be withdrawn from the catheter. (b)...
Figure c17/c17f008
Figure 17.8
Venous Assessment Tool (VAT) score. Source : Reproduced from Wells ( ) with permission of Nursing Standard .
Figure c17/c17f012
Figure 17.12
Anchoring the vein with the thumb. Source : Reproduced from Dougherty ( ) with permission of John Wiley & Sons.
Figure c17/c17f016
Figure 17.16
I‐DECIDED: IV Assessment and Decision Tool. Source : Reproduced from Ray‐Barruel et al. ( ) with permission of BMJ .
Figure c17/c17f020
Figure 17.20
(a) Cannula in situ . (b) Cannula secured with a semi‐permeable transparent IV film dressing.
Figure c17/c17f024
Figure 17.24
Ultrasound cross‐sectional image of the right internal jugular vein (IJV) without compression through the probe. Image orientation as seen from the he...
Figure c17/c17f028
Figure 17.28
Electrocardiogram (ECG) tracing showing P wave changes depending on catheter tip position.
Figure c17/c17f032
Figure 17.32
Royal Marsden NHS Foundation Trust algorithm for the management and treatment of CVAD‐related thrombosis. CVAD, central venous access device; LMWH, lo...
Figure c17/c17f036
Figure 17.36
One way to achieve the Trendelenburg position.
Figure c17/c17f040
Figure 17.40
Implantable port cross‐section, accessed with non‐coring needle.
Figure c17/c17f044
Figure 17.44
The Allen test.
Figure c17/c17uf005
Figure 14
Opening the equipment.
Figure c17/c17uf009
Figure 27
Applying digital pressure and removing the stylet.
Figure c17/c17uf013
Figure 33
Semi‐permeable transparent IV film dressing.
Figure c17/c17uf017
Figure 22
Puncture through the skin, 0.5–1.0 cm below the probe, at the selected angle.
Figure c17/c17uf021
Figure 32
Method for taping a peripheral cannula.
Figure c17/c17uf025
Figure 22
Making an incision with a scalpel.
Figure c17/c17uf029
Figure 29
Making an incision with a scalpel.
Figure c17/c17uf033
Figure 10
Flushing a port.