Trendelenburg position

When hypotension occurs place the patient in trendelenburg position. 

In hypovolemic patients, in patients with impaired sympathetic autonomic activity, and in patients operated on in the anti-Trendelenburg position, extreme falls in blood pressure can occur with D-tubocurarine. Hypotension is aggravated by the use of halothane in particular, and by other drugs that produce circulatory depression. In such cases, and in patients with hypertension, coronary artery disease, and arteriosclerosis, D-tubocurarine is better avoided. 

Hypotension or antabuse -type reactions should be treated by placing the patient in the Trendelenburg position, providing intravenous fluids, including plasma or blood if necessary, and vasopressor drugs. 

Acute treatment Place patient in Trendelenburg position... 

If severe hypotension occurs after exposure to nitrates and aphos-phodiesterase inhibitor, the patient should be placed in a Trendelenburg position and aggressive fluid administration should be initiated. If severe hypotension continues, parenteral a-adrenergic agonists (e.g., dopamine, levarterenol, or epinephrine) should be cautiously administered. 

The Trendelenburg position is head down and would increase intracranial pressure. 

Place the client in the Trendelenburg position before beginning the medication. 

Increased hydration/wide-open Ivs An awake, cooperative patient Elevate lower extremities/wedge Trendelenburg position (if available)... 

Air embolism is a complication associated with the use of the Seldinger technique with a percutaneous sheath set. Air embolism is a well-known, well-documented complication of the percutaneous approach. To avoid this problem, it has been recommended that the patient be well hydrated and placed in the Trendelenburg position. The most important step in prevention is awareness on the part of the implanting physician for the risk of air embolization. There are many steps that may be taken to avoid this complication (Table 4.21) (192). The time of greatest risk is when the dilator is removed from the sheath set. In patients with a volume-overload state, there is little or no risk. On the other hand, an elderly dehydrated patient who has been NPO for many hours is at risk for serious air embolization. It is reconunended that prior to any percutaneous pacemaker or ICD procedure, the patient be maintained in a mild state of overhydration. The patient s state of hydration should be assessed just prior to removal of the dilator. 

Air embolism is rare, it can be prevented by placing the patient in Trendelenburg position, while inserting the catheter through the external jugular or the subclavian vein and by securing the connection between venous catheter and infusion-set. 

Treatment of minor adverse events may include reassurance, cessation of therapy, and supportive care. In cases of recent overdose, activated charcoal and a saline or sorbitol cathartic should he introduced into the stomach via nasogastric tube. Reassurance and/or benzodiazepines may be used if psychotic reactions, panic, or severe agitation are present. For hypotensive reactions, intravenous fluids and Trendelenburg positioning are usually adequate without the need for pressors or other drugs. 

Venous access is accomplished with either a 19- or 21-G needle using real-time US guidance and a one-wall technique. The incompetent truncal vein can become much smaller when the patient lies down. Placing the patients in the reverse Trendelenburg position and keeping the procedure room warm can dilate the vein to make access easier. Also, when the puncture is directed into a tributary vein or the AAGSV, care must be taken to avoid venospasm, which is much more common with missed punctures of these veins. 

After placing the patient in a Trendelenburg position to further empty the vein of blood, the sheath and fiber are withdrawn as a unit through the treated vein segment as the laser is activated. With DUS, gas bubbles can be seen to emanate from the tip of the laser fiber which serves as additional confirmation of the tip position at the appropriate location. 

At autopsy, with all muscles relaxed and the intraabdominal pressure diminished, this condition may easily be overlooked, and only scattered reports of a few cases were therefore known in the literature of the pre-radiological era. The conventional technique of X-ray examination of the stomach with the patient in upright posture usually also fails to visualize these hernias. Examination in recumbent or even Trendelenburg position with application of manual pressure toward the upper abdomen is necessary to produce and demonstrate the condition under the fluoroscope. It is usual for these hernias to disappear as soon as the patient is brought back into upright posture or the increased abdominal pressure is released. 

Trendelenburg position of the patient helps to avoid air embolism... 

Another serious complication is air embolism during CVC insertion into jugular or subclavian vein. As a prevention, mild Trendelenburg position and/ or Valsalva maneuver is recommended. 

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