t is a moment of great pleasure and immense satisfaction for me to express deep

 gratitude and gratefulness to my father Er VK Agarwal and my mother Smt Asha

Agarwal for inspiring me to bring out this book.

I am especially thankful to Shri RP Singal Ji, Chairman, RP Educational Trust, for

his all time support and encouragement. My special thanks to Er Bharat Singal, and

Anuj Singal, Secretary, RP Educational Trust, for inspiring me to bring out this book.

I am indebted to Shri DL Mittal, Director, RPIIT Technical and Medical Campus, for

his motivation.

I am also thankful to CBS Publishers and Distributors. I would like to put on record

the sincere efforts of Mr YN Arjuna (Senior Vice President Publishing, Editorial and Publicity)

and his team comprising of Ms Ritu Chawla (GM Production), Mr Parmod Kumar

(DTP Operator) and Mr Rohan Prasad (Graphic Designer), for bringing out the book

in the present form.

My completion of this project could not have been accomplished without the support

of my loving daughter Shreya and son Vaidish who have allowed me time away from

the writing and research work.

Last but not the least, I express my love to my wife Dr Shilpi for her caring, motivating

and supportive nature. Her encouragement was always there when the times got rough.

It was a great comfort and relief that she kept me away from our household activities

during the entire tenure of writing and research work.

To my numerous students, whom I cannot possibly name individually, I thanks for

their class interactions which have been the guiding spirit in selection of the subject

matter and its logical arrangement.

Gaurav Agarwal

Acknowledgements

I

 

Industrial

Pharmacy II

Gaurav Agarwal

MPharm (BITS–Pilani) PhD

Dean, Faculty of Pharmacy

RP Inderaprastha Institute of Technology

Karnal, Haryana

Jyoti Ghangas

MPharm (Amity University, Noida)

Assistant Professor, Faculty of Pharmacy

RP Inderaprastha Institute of Technology

Karnal, Haryana

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As per the latest syllabus prescribed by

Pharmacy Council of India

for Bachelor of Pharmacy Course

Disclaimer

Science and technology are constantly changing fields. New research and experience broaden the scope of

information and knowledge. The authors have tried their best in giving information available to them while

preparing the material for this book. Although, all efforts have been made to ensure optimum accuracy of the

material, yet it is quite possible some errors might have been left uncorrected. The publisher, the printer and

the authors will not be held responsible for any inadvertent errors, omissions or inaccuracies.

eISBN: xxxx

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Preface

T he book Industrial Pharmacy II is designed specifically as per PCI (Pharmacy

Council of India) B Pharmacy Seventh Semester students. The book covers the

entire syllabus prescribed by PCI Course Regulation, 2014 in a very simple and precise

manner to meet the demanding needs of the pharmacy aspirants. This book covers

wide areas and contains a comprehensive description of current existing knowledge

of drug regulatory affairs. The text not only deals with the basic concepts but also

emphasizes technical and practical aspects of the subject. The book is primarily intended

as a textbook for students of pharmacy for degree and masters courses in drug

regulatory affairs. The book is also of great help for technocrats who want to pursue

career in regulatory affairs department in pharmaceutical industry. Being an

interdisciplinary subject, it is today covering a wide range of interest among the

students, teaching and industry people. Taking this increasing interest into account,

this book gives a comprehensive introduction to the subject.

The book contains numerous specimens, vivid illustrations, tables, diagrams and

flow diagrams to present the ideas. The distinguishing feature is a summary of all the

units at the end of each unit. The structure and the content of the book have changed

to reflect modern thinking and current university curricula throughout the world. In

spite of great care there might be some mistakes and deficiencies. We will be grateful

for giving suggestions to improve. So go through the content and do mail to me at

gbitsian@rediffmail.com.

Gaurav Agarwal

Jyoti Ghangas

I

 

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Representatives

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Pune

Nagpur

Manipal

Vijayawada

Patna

to

my father

Sh. Ram Kumar Ghangas

—Jyoti Ghangas

 

negligence in, 18

from neonatal patient, 20–21

patient-centered approach, 19, 20

physician-centered approach, 19

provider–patient relationship, 18

specific, 19

Infrared electronic thermometry, 44

Infrared thermometers, 45–46

Infusions, intraosseous, 363–366. See also

Intraosseous infusions

Insensible water loss (IWL), 24

Intestinal stomas, 292

Intraosseous infusions

complications of, 366

contraindications to, 363

equipment in, 363, 364f

indications for, 363

infusates in, 364t

precautions in, 363

technique in

via distal femur, 365f, 366

via distal tibia, 366, 366f

via proximal tibia, 363–366, 365f

Intravascular pressure monitoring, 60,

63t. See also Blood pressure

monitoring:continuous

Intravenous line placement

peripheral, 142–150 (See also

Peripheral intravenous line

placement)

Intubation, endotracheal, 236–248. See

also Endotracheal intubation

Index 425

Iodine solutions

contraindications to, 33

properties of, 34t

Iodophors, 34t

Iris vessels, dilation and tortuosity of,

373f

Irradiance, 357

Irradiance, spectral, 357–358, 359t

Irritability, 23

J

Jugular veins, 203, 203f

external, puncture of, 93, 93f

K

Kimura platinum spatula, for eyelid

scraping, 131

Kolb’s experiential learning cycle’, 2–3,

5, 5f

Konica Minolta/Air-Shields JM-103

Jaundice Meter, 81, 82f

Korotkoff sounds, 56

L

Laerdal intraosseous trainer, 8t

Laerdal® infant airway management

trainer, 8t

Lamp, heat, 24–25

Lancets, stylet-type nonautomated, 100

Laparoscopic gastrostomy, 287–288

Larynx, 251, 252f

Laser treatment, for retinopathy of

prematurity, 372–375

Latex allergy, 35, 38

Life/form® Micro-Preemie Simulator,

15t

Lingual frenotomy

background on, 396–397, 397f

complications of, 400

contraindications to, 397–398

definitions in, 396

equipment in, 398

indications for, 397

limitations of, 398

precautions in, 398, 398f

purpose of, 396

technique in, 397f, 398–400, 398f,

399f, 400f

Lingual frenulum, 396

Low-molecular-weight heparin

(LMWH), for catheter-related

thromboembolism, 225

Lumbar puncture

complications of, 107

contraindications to, 104

equipment in, 104–105

indications for, 104

precautions in, 105

technique in, 105–107, 105f,

106f, 107f

M

Manipulation, 20

Manometers, 56

Mattress, warming, 25

McComb reservoir, 369f

McCoy culture, for ophthalmic

Chlamydia, 131–132

Median nerve, muscles supplied

by, 191f

Mediastinal drainage, anterior, 270

soft mediastinal tube insertion in,

270–271

temporary mediastinal drainage with IV

cannula in, 271–272

Mercury-in-glass thermometer, 44

Metabolism, inborn errors of, 134

Mitten restraint, 28–29

Multiparameter neonatal monitoring

system

for blood pressure, 61

for cardiac monitoring, 50f

transport vs. bedside, 50f

Mummy restraint, 27, 28f

N

Nasal anatomy, 394f

Nasal compression, without septal

deviation, 394f

Nasal gastric tubes

complications of, 281, 282f, 283f

contraindications to, 279

equipment in, 279

indications for, 279

limitations of, 279

precautions in, 279

special circumstances in, 279

techniques in, 279–281, 280f, 280t

Nasal septum, 394f

Nasal septum, dislodged, relocation of,

393–394

Nasotracheal intubation. See also

Endotracheal intubation

blind, 416

technique in, 242–243

Natal teeth, 389–392

Needle

break-away, 197

Osgood bone marrow, 123, 124f

peel-away introducer, 197

venipuncture, safety-engineered, 91f

Negligence, 18

Neonatal abstinence syndrome, 39

Neonatal cuff, 57t

Neonatal intensive care unit (NICU), 18,

386, 387

Neonatal resuscitation baby, 10t

Neonatal Resuscitation Program™, 2

Neonatal teeth, 389–392

Nerve block, penile dorsal, 347, 347f

Neural tube defects, maintaining thermal

homeostasis with, 26

Newborn anne, 9t

Newborn simulators, 10t

Nita newborn, 9t

Nitroglycerin, topical, managing

extravasation of, 153–154

Noninvasive blood pressure (NIBP)

measurement, 58

Nonsteroidal antiinflammatory drugs

(NSAIDs), recommended dosages

for, 402t

Normal body temperature, 23

Nursing baby, 11t

O

 

Omphalocele

maintaining thermal homeostasis

with, 26

transection of, in umbilical artery

catheterization, 170, 170f

Ophthalmic specimen collection

Chlamydia identification equipment

in, 131–132

complications of scraping in, 133

conjunctival cytology interpretation

in, 133

contraindications to, 130

indications for, 130, 131t

materials in, 130–131

special considerations in, 130

technique in, 132–133, 132f

Oral intubation, nonvisualized, 416

Orotracheal intubation. See also

Endotracheal intubation

technique in, 239–242, 239f, 240f,

241f, 242f, 243f

tube change in, elective, 415

Oscillometric measurement, of arterial

blood pressure, 58–60, 58f

Osgood bone marrow needle,

123, 124f

Ostomies

assessment of, 292–294, 294f

care of, 294–295, 295f

complications of, 297, 298t

equipment in, 295–296, 295t

gastrostomy tubes in, 299, 299t, 300t

(See also Gastrostomy tubes)

indications for, 292

pouch application in, 296–297, 297f

pouch emptying in, 297

types of, 292, 293f

vesicostomy care in, 297, 299

Ostomy pouch, 294

Otitis media, acute, tympanocentesis

for, 120

Otoacoustic emissions (OAE), 385,

386f, 387

Oxygen (O2)

percent saturation of, 65

skin and environment temperature

gradient on consumption of, 46

transcutaneous measurement of, 69

(See also Transcutaneous blood

gas monitoring)

transport of, 65

Oxygen-hemoglobin affinity curve,

65, 66f

Oxyhemoglobin saturation, arterial

(SaO2, SpO2), 65

P

Packed red blood cell (PRBC)

transfusions, 304

Paracentesis, abdominal, 139–140,

140f

Patient-centered approach, 19, 20

426 Index

PCO2, umbilical artery monitoring

of, 73

PDA Baby, 17t

Pedi-Cap CO2 detector, 241, 241f

Peel-away introducer, for percutaneous

central venous catheterization,

197

Penile dorsal nerve block, 347, 347f

Percutaneous gastrostomy

endoscopic, 288

image-guided, 288

Percutaneously inserted central catheter

(PICC), 85

Pericardial drain, 273

Pericardial effusion, 273

pulsus paradoxus from central venous

catheterization in, 210

Pericardial space, 273

Pericardiocentesis

background on, 273–274, 274f

complications of, 277

contraindications to, 274

definitions in, 273

equipment in, 274–275

indications for, 274

limitations of, 274

precautions in, 274

procedure, 275–276, 275f, 276f

purpose of, 273

special circumstances in, 276–277

techniques in, 274–275

Pericardium, 273

Perimortem evaluation, 134

Perimortem sampling

autopsy, 137

background on, 134

of blood, 135, 136t

of cerebrospinal fluid (CSF), 135, 136t

clinical information, 134–135

family, discussion with, 134

general guidelines, 135

imaging, 137

indications for, 134

of liver, 135–136, 136t

of muscle, 136–137, 136t

photographs, 135

of placenta, examination of, 135

postmortem family conference, 137

of skin, 135, 136t

of urine, 135, 136t

Peripheral arterial cannulation

complications of, 190, 190f, 192

contraindications to, 182

equipment in, 182–183

indications for, 182

obtaining arterial samples in, 189

precautions in, 183

removal in, 190

technique in, nonstandard

posterior tibial artery cutdown,

187, 189

radial artery cutdown, 185–187,

188f, 189

technique in, standard, 183

dorsal pedis artery, 184, 185f

method A, 184, 187f

method B, 184–185, 186f

posterior tibial artery, 184, 186f

radial artery, 183, 183f, 184f

ulnar artery, 183–184, 184f

Peripheral intravenous line placement

conversion to heparin lock of, 149–150

cutdown placement in great saphenous

vein

complications of, 149, 150f

contraindications to, 147

equipment in, 147–148

indications for, 147

overview of, 146

precautions in, 148

technique in, 148–149, 148f, 149f

percutaneous method

complications of, 144, 146, 146f

equipment in, 142, 143f

indications for, 142

precautions in, 142–143

technique in, 143–144, 144f, 145f

Peripherally inserted central catheter

(PICC). See also Central venous

catheterization

break-away or peel-away introducer

needle placement in, 197

care and maintenance in, 202

catheter site examination in, 201t

dressing application in, 201,

200f, 201f

dressing changes in, 201–202, 201t

insertion sites in, 196

insertion variations in, 196–197,

197f, 198f

placement of, 197–201, 198f, 199t,

200f, 201f

Peritoneal dialysis

acute

complications of, 381t, 383

contraindications to, 378

equipment in, 378–379, 379f, 380f

indications for, 378

management in, 382

monitoring in, 383

preprocedure care in, 379–380, 380f

procedure in, 380, 382

continuous arteriovenous

hemofiltration, 378

continuous venovenous hemofiltration,

378

Persuasion, 20

pH, umbilical artery monitoring of, 73

Phentolamine, managing extravasation

of, 154

Phototherapy

complications of, 361

contraindications to, 357

discontinuation of, 361

efficacy, 360

equipment in

fiberoptic systems in, 358–359

fluorescent tubes in, 358

gallium nitride light-emitting diodes

in, 359

halogen lamps in, 358

irradiance, 357

spectral irradiance in, 357–358, 359t

spectral qualities, 357

follow-up in, 361

guidelines for, 358f, 358t

home, 360

indications for, 357, 358f, 358t

technique in

conventional, 359–360

fiberoptic, 360

Physical restraints, 27. See also Restraint

methods

Physician-centered approach, 19

Pigtail catheter, for pleural drainage,

255, 256f

Plasma products, 414t

Plastic heat shields, rigid, 24

Platelet products, 413t

Platelet transfusions, 308–310. See

also Blood and blood product

transfusion

Plateletpheresis, 303

Pneumography, transthoracic impedance,

53f

Pneumomediastinum, 254

vs. pneumothorax, 260f

tension, 271f

Pneumopericardium, 273

Pneumothorax vs. pneumomediastinum,

260f

PO2

arterial, vs. pulse oximeter percent

saturation, 66f

umbilical artery monitoring of, 72–73

Posterior tibial artery

cannulation of, 184, 186f

cutdown cannulation of, 187, 189

puncture of, 97, 97f

Posterior tibial nerve, muscles supplied

by, 191f

Posterior tongue tie, 396

Postmortem family conference, 137

Post-rewarming care, initiate, 341

Pouches, ostomy, 294

Preservatives, for punch biopsy, 128t

Probe-type electronic thermometers, 44,

45, 45f

Prothrombotic disorders, 226t

Proximal greater saphenous vein

puncture, 92–93, 93f

Pulmonary interstitial emphysema, 257

Pulse oximetry

arterial oxyhemoglobin saturation

in, 65

arterial PO2 vs. pulse oximeter percent

saturation in, 66f

background on, 65–66, 66f

complications of, 69

definitions in, 65

equipment in, 67–68, 68f

indications for, 66–67, 66f

limitations of, 67

precautions in, 68

technique in, 68–69, 68f

Pulsus paradoxus, 273, 274f

pericardial effusion from central

venous catheterization in, 210

Index 427

Punch skin biopsy

complications of, 129

contraindications to, 127

definition, 127

equipment in, 127

indications for, 127

precautions in, 127–128, 128t

technique in, 128–129, 128f

types, 127

R

Radial artery

anatomic relations of, 183, 184f

cannulation, 183, 183f, 184f

by cutdown, 185–187, 188f, 189

standard, 183, 183f, 184f

puncture of, 96–97, 96f

Radiant warmed bed, 25

Recombinant tissue plasminogen

activator (r-tPA), for catheterrelated thromboembolism, 225

Reconstituted whole blood transfusion, 308

Rectal probe, 48

Rectal temperature sensors, 325–326, 325f

Resident flora, 33

Respiratory monitoring

background on, 52–53, 53f

complications of, 54, 54f

consumables for, 54

contraindications for, 53

hardware for, 53–54

precautions in, 54

purpose of, 52

techniques for, 54

Restraint methods

complications of, 32

contraindications to, 27

elbow (freedom splint), 29–30, 30f

extremity (wrist or ankle), 28, 29f

for procedures/positioning, 27, 28f

for vascular access, 30, 30f, 31f

indications for, 27

mitten, 28–29

mummy, 27, 28f

precautions in, 31–32

special considerations, 32

Retina, 371, 372f

Retinopathy of prematurity (ROP)

classification of, 371–372, 372f, 373f

follow-up for, 371, 372t

intravitreal injection for, 375–377

laser treatment for

contraindications to, 372

equipment in, 373–374, 373f

indications for, 372

personnel in, 372–373

postoperative care in, 375

precautions and complications in,

374–375, 374t

technique in, 375, 375f

outcome in, 377

postdischarge care in, 377

screening for, 371, 372t

staging of, 371

Retrograde intubation, emergency,

416–417

Rh type, 304

Riga-Fede disease, 389, 390

Rigid plastic heat shields, 24

S

S100 Newborn, 12t

S100 Susie® and Simon®, 11t

S108 PREMIE™ Blue Simulator, 14t

S3009 Premie HAL®, 16t

S3010 Newborn HAL® Mobile Team

Trainer, 16t

S320 PEDI® Airway trainer newborn, 13t

Scalp vein puncture, 92

Screening, hearing, 385–387. See also

Hearing screening

Scrub, 35

Sedation

agents for, 402t–408t

background on, 39

conscious, 39

contraindications to, 41

deep, 39

indications for, 39–40

nonpharmacologic approaches to, 41

precautions in, 40–41

Selective head cooling (SHC)

disadvantages, 330

equipment in, 326, 327f

precautions in, 330, 330f

technique in, 327f, 328–329, 328t,

329f, 330f

Septal dislocation, nasal, 393

Septal forceps, 393

Servocontrolled heating devices, 48t

Silastic gastric feeding tube, 279f

SimBaby™, 16t

SimNewB™, 16t

Simulation-based learning

Bloom’s taxonomy, 2, 5f

Kolb’s experiential learning cycle, 2–3,

5, 5f

procedural skill learning, 5–6

Simulation-based training

focused observation and recording, 6

learning objectives, 6

optimal simulator, 6, 7t–17t

postscenario debriefing, 6

prepractice activities, 6

prescenario briefing, 6

rehearse in advance, 6

simulation environment, 6

simulation session, evaluation of

Skin biopsy

excisional, 127

incisional, 127

punch, 127–129, 128f, 128t

Skin cracking, from frequent hand

washing, 35

Skin preparation, patient, aseptic

technique in, 35

Skin surface probe, 47, 47t

Skin tags, 344–345, 345f

Specific informed consent, 19

Spectral irradiance, 357–358, 359t

Spectral qualities, of light, 357

Sphygmomanometer, 56

Standard of care, 18

Stomas, intestinal, 292

Streptokinase, for catheter-related

thromboembolism, 228

Stress, cold, 23

Stylet-type lancets, 100

Subdural tap

complications of, 111

contraindications to, 109

equipment in, 109

indications for, 109

precautions in, 109

technique in, 109–110, 110f

Sucking, non-nutritive, for analgesia and

sedation, 41

Sucrose, for analgesia and sedation, 41

Suctioning, tracheal, 244–245

Superficial abscess

drainage of, 354–356, 355f

Superficial venous system, in neonate, 90f

Suprapubic bladder aspiration, 112–114,

113f

Suture material, 410t

Swaddling

analgesia and sedation with, 41

in heel-stick procedures, 41

T

Tamponade, cardiac, 273

Tap

subdural, 109–111 (See also Subdural

tap)

ventricular reservoir, 368–369, 369f,

369t (See also Ventricular

reservoirs, tapping)

Tape bridge, 264, 265f

Tecotherm Neo,337–338, 337f, 338f

Teeth, natal and neonatal

clinical assessment of, 389

clinical presentation of, 389, 390f, 391f

complications of, 392

definition of, 389, 389t

etiology of, 389, 389t

precautions in, 390

technique in, 390–392

Temperature

normal body, 23

umbilical artery monitoring of, 73

Temperature monitoring. See also

Thermometers

continuous

background on, 45–46

complications of, 48, 48t

contraindications for, 46

hardware and consumables for, 46–47

indications for, 46, 46f

precautions in, 47

purpose of, 45, 46f

technique of, 47, 47f, 47t

intermittent

complications of, 45

equipment, 44, 45f

limitations of, 44

precautions in, 44–45

technique of, 45

site for, 47t

428 Index

Tension pneumomediastinum, 271f

Thermal homeostasis, maintenance of,

10–13

background, 23–24

in delivery room, 24, 24t

indications for, 24–25

mechanical devices for, 25, 25f

in NICU, 24–25

special circumstances/considerations

in, 26

Thermal resistor, 25

Thermistor probes, 46

Thermocouple probes, 46

Thermometers

electronic digital, 44, 45f

infrared electronic, 44

mercury-in-glass, 44

probe-type electronic, 44, 45, 45f

Thermoregulation, 23

Thoracostomy

air evacuation in, emergency, 269

anterior mediastinal drainage in,

270–272

chest tube evaluation in, 262f

complications of

equipment malfunction in, 269

infection in, 269

lung perforation in, 266, 266f

nerve damage in, 266

other, 269

trauma in, 266

tube misplacement in, 269

contraindications to, 255

equipment in, 255–256, 256f, 257f

indications for, 255

pleural fluid diagnostic tap in, 270

precautions in

air leaks in, 259, 262f

depth of penetration in, 259, 261f

insertion site in, 257, 259f, 261f

pleural air collection vs. skin folds in,

257, 258f, 259f, 260f

purse-string suturing in, 259, 268f

transillumination, recognizing, 257

technique in

anterior tube insertion for

pneumothorax in, 259–262

posterior tube insertion for fluid

accumulation in, 264–265

removal of tube in, 265

Thromboembolism, 225–228

Thrombosis

anticoagulation/fibrinolytic therapy

complications in, 228

assessment of, 224, 225t

catheter-related, managing

anticoagulant/thrombolytic therapy

in, 227

arterial thrombosis, 226–227

general principles of, 225–226

thrombolytic agents in, 228

venous thrombosis, 226

definition of, 224

surgical intervention, 228

umbilical artery catheterization in,

167, 169f

Tibia, 365f

Tibial artery, posterior

cannulation of, 184, 186f

cutdown cannulation of, 187, 189

puncture of, 97, 97f

Tibial bone marrow biopsy, 123–125. See

also Bone marrow biopsy, tibial

Tolerance, 39

Tongue clipping, 396

Tongue tie, 396

Tooth assessment, 389

Total serum bilirubin (TSB), 79

Tourniquet, quick release application of,

91f

Tracheal suctioning, 244–245

Tracheotomy

complications of, 253–254, 253f

contraindications to, 251

equipment in, 251

indications for, 251

postoperative management in, 253

precautions in, 251

technique in, 251–253, 252f, 253f

Transcutaneous bilirubin (TCB),

monitoring, 79–82

Transcutaneous blood gas monitoring,

69–72. See also Blood gas

monitoring: transcutaneous

Transfusion

blood and blood products, 303–313

(See also Blood and blood product

transfusion)

exchange, 315–321 (See also Exchange

transfusions)

Transfusion-associated graft-versus-host

disease (TA-GVHD), irradiation

for prevention of, 304

Transient flora, 33

Transport media, for punch biopsy, 128t

Transpyloric feeding tube

complications of, 284

contraindications to, 281

equipment in, 281

indications for, 281

limitations of, 281

precautions in, 281, 283

special circumstances in, 283

techniques in, 283–284

Transthoracic impedance pneumography,

53f

Tympanic membrane, in adult vs. infant,

121f

Tympanic membrane thermocouple

probe, 47

Tympanocentesis, 120–122, 121f

U

Ulnar artery, 183–184, 184f

Ulnar nerve, muscles supplied by, 191f

Umbilical arteries, 158f

Umbilical artery catheterization

catheter care in, 165

catheter length for, 156

complications of

air embolism in, 167, 170f

congestive heart failure in, 167

embolism/infarction in, 167, 168f

equipment-related, 167

hypertension in, 167, 169f

loss of extremity in, 167, 169f

malpositions in, 166f, 167, 167f, 168f

omphalocele transection in,

170, 170f

other, 167, 170

paraplegia in, 167

thrombosis in, 167, 169f

vasospasm in, 167

contraindications to, 156

cutdown for, 163–165, 164f

equipment in, 156–157

indications for, 156

obtaining blood samples in, 165

precautions in, 157–158

removal in, 165–167

technique in

alternative (cutdown), 163–165, 164f

anatomic note, 158, 158f, 159f

catheter insertion in, 161f

cutting cord in, 160, 160f

high position in, 159–163, 160f,

161f, 162f

identifying cord vessels in, 160, 161f

low position in, 159, 159f

preparation and draping in, 163

securing catheter in, 163

umbilical tie in, 160

Umbilical artery, continuous PO2, PCO2,

pH, and temperature monitoring

via, 73

Umbilical vein catheterization

complications of

embolism in, 175

hepatic infarction in, 180f

malpositioning in, 175, 177, 177f,

178f–179f

other, 177

contraindications to, 173

equipment in, 173

indications for, 173

precautions in, 173

technique in

anatomic note, 173–174, 174f

identification in, 174, 174f

radiographic verification, 174, 175f

securing catheter in, 175

venous and arterial pressure tracings

in, 174, 176f

Ureterostomies, 292

Urokinase, for catheter-related

thromboembolism, 228

Urostomies, 292. See also Ostomies

V

V800 Nita Newborn™, 12t

Vallecula cyst, 237f

Vascular spasm

definition of, 224

management of, 224–225, 225f

Vascular thrombosis, diagnosis of, 225t

Venipuncture

complications of, 93–94

contraindications to, 89

Index 429

equipment in, 89, 91f

indications for, 89

precautions in, 89

special considerations for neonates,

89, 90f

techniques in, 91–93, 91f, 92f, 93f

Venoarterial extracorporeal membrane

oxygenation, cannulation in

contraindications to, 213

equipment in, 214, 214f, 215t

indications for, 213

medications in, 214

personnel, 213

precautions in, 213

technique in

arterial cannulation in, 216–217, 217f

preparation in, 214–216, 215f, 216f

venous cannulation in, 217–218, 218f

Venous system, superficial, 90f

Venovenous extracorporeal membrane

oxygenation, cannulation in

advantages of, 219

closing neck wound in, 220

complications of, 220–221

conversion to venoarterial ECMO of, 221

disadvantages of, 219

double-lumen venovenous catheters

in, 219

overview and schematic of, 218

placing patient on ECMO circuit in,

219–220, 220f

technique in, 219

Ventricular reservoirs, tapping

complications of, 369t

contraindications to, 368

equipment in, 368

follow-up after, 369

indications for, 368

precautions in, 368

success in, 369

technique in, 368–369, 369f

Vesicostomy, 292

Vessel localization

near-infrared visualization, 88, 88f

transillumination, 85, 86f

ultrasonography, 85–88, 86f, 87f

W

Walsham septal forceps, 394f

Warming mattress, 25

Whole blood products, 411t

Whole blood transfusion, 308. See

also Blood and blood product

transfusion

Whole body cooling, 330

Blanketrol III, 338–339, 339f

cooling with adjuncts, 331–333, 332f

CritiCool, 333–337, 334f, 335f, 336f,

337f

Gels5, 332, 332f

manual control cooling machine, 333,

333f

passive cooling, 330–331

servocontrolled cooling machine, 333

servocontrolled fan, 332–333

Tecotherm Neo, 337–338, 337f, 338f

Withdrawal, 39

Wound management, in neonates, 154

Wrist

major arteries of, 184f