How Not to Blow a Vein.....

As an IV therapy nurse, no matter how “pro” you consider yourself to be, there are still times when you encounter problems when it comes to IV insertion, such as very fragile veins.
Here are some tips to avoid blowing veins in IV insertion.
Assess. Feel the veins.
Don’t just look at a vein, instead, try palpating the area to search for a vein. It is important to palpate using your index and third finger pad to evaluate the vein’s resilience, patency, valves, and size. Check if the vein is straight, soft and bouncy, and large enough to accommodate the catheter needed for the IV therapy. Go for the straightest vein. For geriatric patients, a deeper vein may be less prone to blowing since they are more stabilized and less movable.
Choose the right size.
This is with regards to the IV cannula to be used. If possible and if not contraindicated, try using smaller sizes. For adults, G-22 is commonly used while for pediatric patients, G-22-26 are used.
Check tourniquet application
A too tight or too loose tourniquet can cause veins not to distend and may result to you cutting off their arterial circulation. A BP cuff may be used as a tourniquet when dealing with very fragile veins of elderly and chemo patients.
Check the bevel. Make sure that it is facing upwards
This technique is done to make sure you don’t blow a vein when advancing forward. Also, you can control the angle of insertion more when the bevel is facing upward as you have easier glided point of entry as the sharp end-tip of the needle enters the skin.
Use warm/hot packs of the arm is cold
This is to dilate the blood vessels and them pop out quickly. Warm washcloths or blanket may be used if hot packs are not available.
Anchor the vein
This is to keep an unstable vein from moving sideways as you puncture it. This can be done by holding the skin and veins taut with your non-dominant hand.
Angle well and insert the catheter directly on top of the vein
Adjust your angle of approach accordingly if your target vein is too shallow or too deep. Usually, you may do it in a 15 to 30 degree angle. Then, insert the vein catheter on top of the vein to reduce the chances of going through the two vein walls. Do it slowly but steadily.
Upon hitting a vein and seeing backflow, stop advancing the catheter and drop the angle approach.
This is to avoid puncturing the vein wall again. Release the tourniquet first. Drop your angle of approach as you advance the catheter a little bit more. Then pull back the needle a little bit before advancing the whole catheter. When you have successfully inserted the catheter, pull back the needle quickly to attach the IV fluid set and start the IV infusion with the first few drops running very slowly.
Use available visualization devices
This may include transilluminator lights and pocket ultrasound machines. These devices will illuminate vein pathways so you can track the direction of where you should insert your IV catheter.
Sources:
http://www.nursebuff.com/2014/10/tips-for-nurses-on-how-to-prevent-blown-veins/
http://piccresource.com/piccnurseblog/how-to-start-ivs-8-tips-to-improve-your-iv-success/

Knee Pain Illustration....

Visual of Sensory Brain Function....

Human Atlas Videos | Health Information | Alberta Health Services

Check out these Amazing 3-D videos .....



Human Atlas Videos | Health Information | Alberta Health Services

NCLEX Review Liver Lecture ....

Arteries of the n brain........

Arteries of the human brain.

Brain Lobe Anatomy.........

Brain Anatomy
The brain and the spinal cord form the central nervous system. Weighing approximately 1-1.5 kg, the brain acts like a computer system regulating many of our bodily processes, including basic functioning, such as respiration, temperature, appetite, movement and cognitive processes like thoughts, memory and emotion.
Protected within the skull, the brain is a symmetrically shaped structure which is divided into 2 hemispheres: the right and a left hemisphere. The left side of the brain controls the right side of the body; the right side of the brain controls the left side of the body.
The cerebral cortex makes up the surface of the brain; it is highly folded giving it a very large surface area. The cerebral cortex is divided into 4 sections: the occipital, parietal, temporal and frontal lobe. Although each lobe is specialised to control particular functions, all work together to control the body.

The Frontal Lobe

The frontal lobe contains four main areas:

• The primary motor cortex - involved in the initiation of voluntary movements, particularly in the execution of distinct, well-defined movements
• The premotor area - which plays a key role in the planning of motor activity and the initiation of voluntary movement by controlling the orientation of the body and its limbs
• The prefrontal cortex - which is implicated in social behaviour and personality
• Broca’s area – is part of the prefrontal cortex and is important in the production of written and spoken language

Parietal Lobe

This has 3 main functions:

• Bringing together information about our sense of touch and joint position
• Making sense of the relationship between objects in space
• Aspects of language comprehension

Temporal Lobe

The temporal lobe contains four key regions:

• The primary auditory cortex receives information from the ears and plays an important role in the detection of patterns of sound and the location of sound
• Wernicke’s area is important in the comprehension of language
• The medial temporal lobe is involved in learning and memory
• The anterior temporal cortex is believed to store facts about people and the world

The Occipital Lobe

This is mainly concerned with vision. The primary visual cortex contains a map of the visual field that receives information from the eyes and relays it to the visual association cortex. The visual association cortex contains around 30 further maps involved in processing information about form, depth, movement and color.

Brain Anatomy....Hippocampus

The amygdala, named in Latin after its likeness to an almond, is located in the brain just in front of the hippocampus.  This is ideal because the amygdala attaches emotional significance to memories, which the hippocampus processes.
While the amygdala is best known and understood for emotional reactions (I.E., rage), when bitemporally lesioned (damaged in both hemispheres), patients tend to not only present with docility, but also hypersexuality with unusual objects and an odd tendency to put objects in their mouths.  This is known as Kluver-Bucy Syndrome.

The Hippocampus

This plays an important role in memory, as demonstrated by the famous case of H.M, a 27 year old patient who was suffering from severe temporal lobe epilepsy. As treatment, doctors surgically removed a region of both his medial temporal lobes which included the hippocampus. The treatment was successful in stopping most of the seizures. However, H.M. experienced a disastrous side-effect from the surgery; he became unable to form new memories.
 Damage to the hippocampus can produce both anterograde and retrograde amnesia but will not affect other aspects of memory, such as the ability to learn new skills (procedural memory) or to store information about meaning and facts (semantic memory).
The hippocampus is also believed to play an important role in storing information about the environmental (spatial) context of events that have happened in the past. Damage to this region is associated with difficulties in navigating through familiar places.

The Amygdala

This is often referred to as the "emotional brain" as it is believed to regulate a large number of emotional states. It is particularly associated with fear and anger.
The amygdala is also thought to be involved in emotional and autobiographical memory. It has the task of identifying the emotional significance of an event and making the event better remembered.

The Mammillary Bodies

These structures relay information from the amygdala and hippocampus to the thalamus. Damage here can impair memory.

The Olfactory Bulb

This controls the body's sense of smell and sends its signals back to the temporal lobes. It is involved in odor detection and discriminating between different smells. This structure also plays a role in emotional memory as distinctive smells are often associated with the memory of an event.

Head Anatomy........

Sagittal section of human head
Here you can see the pituitary gland (hypophysis), a roundish organ that lies immediately beneath the hypothalamus, resting in a depression of the base of the skull called the sella turcica (“Turkish saddle”)...

Sectioned pituitary gland and the hypophyseal portal system within it........

Head Anatomy.........

HEAD, MRI Sagittal section. 1. Brain. 2. Corpus callosum (splenium). 3. Septum lucidum. 4. Thalamus. 5. Mamillary body. 6.Mesencephalon. 7. Pons. 8. Medulla oblongata. 9. Spinal cord. 10. Cerbellum. 11. Frontal sinus. 12. Ethmoid cells. 13. Concha. 14. Sphenoidal sinus. 15. Genioglossus muscle; tongue. 16. Mandible. 17. Rhinopharynx. 18. Oropharynx. 19. Laryngopharynx. 20. Trachea. 21. Soft palate. 22. Bone of the skull. 23. Internal cerebral vein; Great cerebral vein (called of Galien) and right sinus. 24. Forth ventricle. 25. Anterior arch of the Atlas. 26. Posterior arch of the Atlas. 27. Tooth of the axis (called ontoid process). 28. Optic chiasm. 29. Pituitary gland. 30. Clivus (called basilar cap splint)

Skeletal System.........

I).  Function of the skeletal system A).  support B).  protection C).  movement D).  mineral storage E).  blood cell formation
II).  Bones & Muscles  as Levers Levers have 4 components 1).  Rigid bar 2).  Pivot/fulcrum 3).  Object that creates resistance 4). Force that supplies movement http://www.vias.org/physics/bk2_06
When the arm bends the bone represents the rigid bar The elbow joint is the pivot The hand is moved against the resistance or weight (weight of hand) The muscles supply force
III). Skeletal Cartilage:  Hyaline Cartilage Provides support with  flexibility and resilience. A).  Articular cartilage B).  Costal cartilage C).  Nasal cartilage D). Epiphyseal cartilage E).  Embryonic  cartilage
IV). Long Bone Anatomy: A). diaphysis B). epiphysis The epiphysis is usually covered in articular cartilage C). epiphyseal line or plate
http://anatomyforme.blogspot.com/
V). Bone Structure A). compact bone structural units called osteons. Ostean consists of long cylinders that run parallel to the long axis of the bone. Structure of an osteon 1). lamella   2). Haverson’s canal: (oseonic canal) 3). canaliculi or perforating canals 4). lacuna: contain osteocytes (mature bone cells) Types of osteocytes i). osteoblasts: build bone ii). osteoclasts: consume or remove bone

 B). spongy (trabecular) bone

A honeycomb or network of flat pieces called trabeculae that are organized along stress lines

C).  Medullary Cavity

D). Bone Marrow

Soft tissue in the medullary cavity and the trabeculae of the spongy bone

1). red bone marrow:

2). yellow bone marrow:

E). periosteum

The periosteum is supplied with nerve fibers, lymphatic vessels and blood vessels, which enter the bone.
It also contains osteoblasts (bone builders) & osteoclasts (bone breakers)

VI). bone development

A). osteogenesis: Bone tissue formation

1. cell types

i. oseteoblasts: build calcium matrix
ii. osteoclasts: reabsorb calcium matrix

2. ossification: formation of bone

Ossification replaces cartilage with bone matrix

3. Ossificantion Processes

i. Endochondral Ossification:  Long bones ossify---

along hyaline cartilage model

ossify on the outside with compact bone and move inward

ii. Intramembranous Ossification: Flat bones ossify--

from layers of unspecified connective tissue.

ossify inside with spongy bone and work outward to compact bone

B). Intramembranous Ossification of flat bones

1). An ossification center appears in the connective tissue.
2). A bone matrix is secreted in the fibrous membrane.
3). Woven bone and periosteum form.
4). Bone collar of compact bone forms and red bone marrow appears.
Fontanels:  Unossified fibrous membranes

C). Endochrondral Ossification of long bones

1). Formation of hyaline cartilage model
2). A bone collar forms around the diaphysis of the hyaline cartilage
3). Cartilage in the center of the diaphysis calcifies and then cavitates
4). The periosteal bud invades the internal cavity and spongy bone forms.   

                            The bud contains a nutrient artery and osteoclasts

5). The diaphysis elongates and a medullary cavity forms
6). The epiphysis ossify.

*Hyaline cartilage remains on the growth plate and the articulating surface.

VII). Bone Remodeling

Weekly recycle 5% to 7% of bone mass. With a replacement of spongy bone every 4 years and a replacement of compact bone every 10 years.

Bone deposit:

Bone reabsorption:

Controlled by:

1). Negative feedback

Ca++loop that maintains blood calcium.
It involves the hormones: Parathyroid Hormone and Calcitonin.

PARATHYROID HORMONE if blood Ca++ is low  Parathyroid Hormone is released   Ca++ is reabsorbed from bone by osteoclasts

CALCITONIN HORMONE if blood Ca++ is high    Calcitonin is released   Ca++ is absorbed into the bone by osteoblasts

2). Mechanical & gravitational forces.

Wolf’s Law Bone grows where stressors are placed on it.

VIII). Bone Fractures

A).  Classification of fractures

1). non-displaced fractures
2). displaced fractures
3). complete fracture
4). incomplete fracture
5). open (compound) fracture
6). closed (simple) fracture
7). closed reduction
8). open reduction

Mnemonic
	Go C3PO (use 3 Cs) Greenstick Open Complete Closed Comminuted Partial Other

B).  Types of fractures

1). green stick
2). partial or fissure
3). comminuted fractures
4). transverse fractures
5).  oblique fractures
6).  spiral fractures
7).  depressed fractures
8). compressed fractures

IX). Repair of Fractures

STEP1:  A hematoma forms over the fracture site.
STEP2:  Fibrocartilaginous callus formation.
STEP3:  Bony callus formation
STEP4:  Bone remodeling

Movement ........ Movement along the Axis or Range of motion

A). Nonaxial Movement:
B). Uniaxial Movement
C). Biaxial Movement
D). Multiaxial Movement

II). Types of motion

A). Gliding Movements

One flat bone slides over another.

B). Angular Movements

Increase or decrease the angle between 2 bones.

1). Flexion

 

Bending motion that decreases the angle of the joint bringing the 2 bones closer together.

2). Extension

Movement that increases the angle between the 2 bones.

Hyperextension: bending the head backward.

3). Dorsiflexion (of the foot)

Lifting the foot up so that it points to the shin.

4). Plantar (of the foot)

Pointing the foot down.

5). Abduction

	Movement of the limb along the frontal plane.
	Raising an arm laterally or spreading the fingers.

6). Adduction

Movement of the limb toward the body.

 7). Circumduction

Movement of a limb in a circle or cone shape.

C). Rotation

Turning of the bone along its own long axis.

Only movement allowed between first 2 cervical vertebra

D). Special Movements

1). Supination

	Movement of the radius around the ulna.
	palm faces up

2). Pronation

Movement of the radius around the ulna.

palm faces down

3). Inversion

Sole of the foot turns medially

4). Eversion

Sole of the foot turns laterally.

5). Protraction

	Nonangular anterior motion along the transverse plane.
	Jutting the jaw out

6). Retraction

	Nonangular posterior motion along the transverse plane.
	Pulling the jaw back.

7). Elevation

	Lifting a body part superiorly
	Shrugging  shoulders closing the mouth.

8). Depression

	Moving a body part inferiorly
	Opening the mouth.

9). Opposition

Movement of the thumb in relation to other digits.