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what are the 2 types of lidocaine falmily?
ester and amide
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ester family includes?
- benxocaine(americaine, solarcaine)
- cocaine
- procaine(novocaine)
- tetracaine(pontocaine)
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Amide family includes?
- lidocaine(xylocaine)
- mepivacaine(carbocaine)
- prilocaine(cinanest)
- bupivacaine(marcaine)
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instruments needed for Cut-down procedure
- #15 knife blade on handle
- #11 knife blade on handle
- 4-5 curved mosquito hemostats
- 2 straight hemostats
- weitlander self retaining retractor
- iris scissors
- needle holder
- debakey forceps
- adson doeceps with teeth
- umbilical tape
- non absorbable 6.0 prolene
- 3-0 absorbable suture(vicryl)
- silk suture
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how to obtain femoral approach
risk of retroperitoneal bleed if not felt and punctued accurately
- feel iliac crest and pubic bone (imagingary line)
- you should feel the inguinal ligament
- go 2cm below that ligament
- if above the inguinal ligament you can cause retroperitoneal bleed
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locating the vessels
in the femoral approach
going lateral to medial feel for
- Nerve
- Artery
- Vein
- Empty space or epithilial tissue
- Lymph
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lidocaine info
- 2% is most commonly used
- don't use novocaine b/c it contains epi, which will constrict the blood vessels, and will not be ablt to get access
increases HR & BP iff in blood stream
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how much lidocaine used for 1 stick method
1 syringe filled with 2% lidocaine
- 10cc for femoral
- 5cc for radial
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how much lidocaine used for 2 stick?
2 syringes with 10cc lidocaine
- 1 has short needle for superficial tissue
- 1 has long needle for deeper tissue
can use up to 20 cc on average 15cc
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problems with access
got access, loose blood flash
- pull back 1 cm or less, look for flash
- if don't see flash then pull back a little more
- if see flash, put wire back in
- if don't see flash, remove needle, flush needle, hold pressure for 5 min
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got access see blood flash, wire won't advance. what next?
- pull back 1 cm or less, look for flash
- if don't see flash then pull back a little more
- if see flash, put wire back in
- if don't see flash, remove needle, flush needle, hold pressure for 5 min
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what is manual pressure?
- assisted pressure to groin after procedure
- hold for 15min
- if you peak you leak and have to start all over
- for aortic regurge hold for 30 min
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5 types of closure devices?
- vasoseal
- angioseal
- perclose
- startcloser
- boomerang
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vasoseal includes what?
- 2 hr bed rest
- gives solid seal
- insert wire
- remove sheath and hold occlusive pressure
- insert sheath until blood flash
- push dilator in until blck mark on sheath is met at hub
- hold occlusive pressure, pull dialtor
- insert plunger, push collagen into track ( 2 plugs) remove hub
- hold pressure for 5-15 min
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angioseal includes what?
- 2-4 hr bedrest, mostly 2 hr
- most commonly used by MD's.
- with sheath already intact you will
- insert angioseal wire
- remove sheath
- insert angioseal sheath until blood flash seen
- remove wire and dilator, your then committed to artery,
- open closure device
- insert device into sheath
- pull sheath and device back very carefully
- tamp collagen and foot together
- cut suture, remove device
- can cause phlebitis(vasculitis)
- absorbable in pt
- can use with anticoagulants
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perclose device includes what?
sutures arteriotomy closed
- insert wire into sheath
- remove sheath
- insert perclose device
- remove wire=committed
- deploy needle and suture
- remove device
- tie suture
- advance knot
- cut suture length
pt can walk right away with this device
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starcloser includes what?
- same steps as perclose
- except it is uses staples and not sutures
- can use with high ACT
- if miss with this device you will have to hold mannually
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boomerang includes what?
- 2-6 hr bedrest
- same steps as perclose and starcloser, except it has a little foot which is inserted,
- pull back carefully till feel small resistance as you pull, hold for 10-15 min
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What types of patients can not use perclose, starcloser and angioseal?
- pt that has had a side stick to artery
- pt that has small vessels
- pt that has bifurcations
- pt that has stenosis
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