![]() ![]() Topical anesthetics like EMLA, LMX or AMETOP can be used to numb the area to be used for venipuncture. Minimizing pain has also been shown to lead to quicker, more successful IV insertions and blood draws, reduces anxiety in those who have a fear of needles, and of course increases patient satisfaction. We of course won’t be able to implement these strategies in emergent situations, but when we do have the time, we need to do everything we can to reduce the pain associated with venipuncture in order to prevent these stress responses. Since pain is such a strong factor in conditioning, it can actually cause PTSD-like symptoms in some people, particularly those who are frequently in the hospital for chronic conditions. In Wikipedia.Pain management is a severely underutilized strategy for IV insertion in the adult population. Smith-Gabai (Ed.), Occupational Therapy in Acute Care(1st ed., pp. Surgical Neurology International, 6(7), 271. External ventricular drains: Management and complications. Extended CSF drainage trial via lumbar drain. If unable to tolerate repeated EVD clamp trials, eventual plan for shunt If clamped drain causes ICP elevation, then it is re-opened re-attempt wean later ![]() If the raised clamped drain is tolerated, EVD is pulled If the raised drain is tolerated, drain stays in but is clamped Per patient tolerance, the drain is raised typically to 20-25 Raising the drain and eventual clamping is a sign of patient improvementĭrain placed due to increased ICP (blood, edema, lesion occupying volume in skull) or hydrocephalus (trauma, blood, tumor obstructing the flow of CSF)ĭrain leveled per ICP needs most aggressive typically 0 and open (some patients may be -5 or more, but this is uncommon) Higher drain = more pressure (ICP) is required to push fluid out through the drain Setting: 0, 10, 15, 20 (lower number means more CSF drainage) HOB usually elevated at 30°Ĭlamped = drain is in place, but not actively draining Precautions: Activity order required for all out of bed activity. Indication: treat excessive CSF in the ventricles (hydrocephalus), following craniotomy until CSF circulation is re-established, to drain infected CSF, or to provide a way to measure ICP and allow CSF drainage to treat elevated ICP (Muralidharan, 2015). Adjusting height or head of bed alignment can change this. Location: external auditory meatus or tragus is the anatomical reference for correct drain alignment. Purpose: Temporary system to drain CSF from the ventricles to an external closed system (Muralidharan, 2015). No contraindication unless device is placed in the femoral region. Precautions: May produce bleeding, vessel rupture, dysrhythmias, and other life-threatening complications. Limit excessive overhead/repetitive movement and avoid ROM to ipsilateral shoulder to ensure line stability. If appropriate specific orders are required. Appropriately only for splinting and positioning. Indication: Critical illnesses affecting heart function such as shock or acute pulmonary edema. Winds through the right side of the heart, ending in the proximal left or right branch of pulmonary artery. Location: Enters in the subclavian or IJ. Allows direct simultaneous measurement of pressures in the right atrium, right ventricle, and pulmonary artery, and the filling pressure (“wedge” pressure) of the left atrium. Monitors intravascular volumes: central venous pressure, cardiac output, & mixed venous saturation of O2. Purpose: to detect heart failure or sepsis, monitor therapy, & evaluate the effects of particular drugs. ![]()
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