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Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures.
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 Science Education: Essentials of Nursing Skills

Central Venous Access Device Dressing Change

JoVE Science Education

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Central venous access devices (CVAD), commonly known as central lines or central catheters, are large-bore intravenous (IV) catheters that are introduced into the central circulation. Typically, CVADs terminate in the superior vena cava, just outside of the right atrium of the heart, but they may also terminate in any one of the great veins (i.e., aorta, inferior vena cava, brachiocephalic vein, pulmonary artery, internal iliac vein, or common femoral vein). Patients may need a CVAD for any number of reasons. CVADs allow for the rapid infusion of fluids to treat significant hypovolemia or shock. They are also beneficial when administering vasoactive medications, highly concentrated medications, total parenteral nutrition (TPN), or chemotherapy, because the increased blood volume in these areas allows for the hemodilution of these potentially caustic or reactive agents. Patients who must receive multiple non-compatible IV medications, those that require long-term IV medications, or those with limited vascular access may also require the placement of a CVAD. These devices may be tunneled (i.e., inserted into a vein at one location and tunneled under the skin to emerge through the skin at another site)

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 Science Education: Essentials of Nursing Skills

Preparing and Administering Enteric Tube Medications

JoVE Science Education

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

An enteric tube is a tube that is inserted and passed into the stomach or intestines. Enteric tubes serve multiple purposes, including stomach decompression (through the removal of air, gastric contents, and secretions), enteric feeding, and/or the administration of medications or oral contrast. Enteric tubes are indicated for patients with impaired swallowing and for patients with neurological or other conditions associated with an increased risk of aspiration, or when the patient is unable to maintain adequate oral intake of fluid or calories. There are multiple types of enteric tubes, with their generic names assigned according to the insertion site and the gastrointestinal termination point. For instance, one of the common tube types is the nasogastric tube, which is inserted through a nostril and passed along the upper gastrointestinal tract into the stomach. When administering medications through an enteric tube, it is important to ensure that the tube terminates in the intended gastrointestinal location. When enteric tubes are initially placed, the position of the tube is verified by X-ray. However, due to gastric peristalsis, enteric tubes may migrate out of their intended

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 JoVE Biology

Murine Aortic Crush Injury: An Efficient In Vivo Model of Smooth Muscle Cell Proliferation and Endothelial Function

1Department of Surgery, Baltimore Veterans Affairs Medical Center, 2Department of Surgery, University of Maryland School of Medicine, 3Department of Physiology, University of Maryland School of Medicine, 4Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine


JoVE 55201

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 JoVE Biology

Removal of Exogenous Materials from the Outer Portion of Frozen Cores to Investigate the Ancient Biological Communities Harbored Inside

1Biogeochemical Sciences Branch, Cold Regions Research and Engineering Laboratory, US Army Engineer Research & Development Center, Hanover, NH, 2Environmental Processes Branch, Environmental Laboratory, US Army Engineer Research & Development Center, Vicksburg, MS, 3Terrestrial and Cryospheric Scienes Branch, Cold Regions Research and Engineering Laboratory, US Army Engineer Research & Development Center, Hanover, NH, 4Biogeochemical Sciences Branch, Cold Regions Research and Engineering Laboratory, US Army Engineer Research & Development Center, Fairbanks, AK


JoVE 54091

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 Science Education: Essentials of Nursing Skills

Peripheral Intravenous Catheter Insertion

JoVE Science Education

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

The purpose of peripheral intravenous catheter (PIV) insertion is to infuse medications, perform intravenous (IV) fluid therapy, or inject radioactive tracers for special examination procedures. Placing a PIV is an invasive procedure and requires the use of an aseptic, no-touch technique. Common IV venipuncture sites are the arms and hands in adults and the feet in children. According to the Intravenous Nurses Society (INS), the feet should be avoided in the adult population because of the risk of thrombophlebitis. Venipuncture sites should be carefully assessed for contraindications, such as pain, wounds, decreased circulation, a previous cerebral vascular accident (CVA), dialysis fistulas, or a mastectomy on the same side. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. The cephalic vein has been associated with nerve damage when used for IV placements. The most distal site available on the hand or arm is preferred so that future venipuncture sites may be used if infiltration or extravasation occurs. This video will demonstrate the insertion of a PIV, including the preparation and attachment of an IV extension s

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 JoVE In-Press

Simultaneous Event-Related Brain Potential Recordings in Pairs of Partners: Assessing the Sensitivity of the Brain to the Percepts of Others

1Douglas Mental Health University Institute, 2Department of Psychiatry, McGill University, 3Department of Neurology and Neurosurgery, McGill University, 4Department of Psychology, McGill University

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JoVE 56120

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 Science Education: Essentials of Nursing Skills

Preparing and Administering IV Push Medications

JoVE Science Education

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Intravenous (IV) push is the rapid administration of a small volume of medication into a patient's vein via a previously inserted IV catheter. Preparations for IV push administration are commonly provided in vials or ampules for withdrawal into a syringe. This method is used when a rapid response to a medication is required, or when the medication cannot be administered via the oral route. For instance, medications commonly administered via IV push are the ones used to treat moderate or severe pain. Before administrating IV push, it is important to confirm the correct placement of the IV catheter, because the push medication can cause irritation and damage to the lining of the blood vessel and to surrounding tissues. Since IV push medications act quickly, the patients need to be closely monitored after the drug has been administered, and any error can be especially dangerous. It is imperative that the nurse adheres to the five "rights" and three checks of safe medication administration and is knowledgeable about the medication purpose and adverse effects. The nurse should determine the appropriate medication dose, based upon the medication concentration in the container. If

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 Science Education: Essentials of Nursing Skills

Preparing and Administering Intermittent Intravenous Medications with an Infusion Pump

JoVE Science Education

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Primary intermittent intravenous (IV) infusions are delivered alone as volume-controlled infusions, while secondary infusions are delivered with another IV fluid, usually maintenance fluids. Intermittent infusions are delivered over a specific amount of time, which is dictated by the type of medication, such as IV antibiotics. High-volume IV medications, anywhere from 50- to 500-mL infusions, are typically delivered using an infusion pump as either primary or secondary infusions. Infusion pumps deliver IV fluids in a volume-controlled manner, keeping medication side effects to a minimum and helping to prevent nurse medication errors. Careful review of the medication compatibility with maintenance fluids using an approved medication drug guide, pharmacy recommendations in the Medication Administration Record (MAR), and physician orders must be assessed prior to delivering an IV medication. This review will determine if primary or secondary delivery is appropriate based on the risk for patient harm, such as for concentrated electrolyte preparations like potassium. Certain medical conditions that preclude oral fluid intake, specific medication preparations, or situations that require an inc

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 Science Education: Essentials of Nursing Skills

Preparing and Administering Secondary Intermittent Intravenous Medications

JoVE Science Education

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Secondary intravenous (IV) infusions are a way to administer smaller volume-controlled amounts of IV solution (25-250 mL). Secondary IV infusions are delivered over longer periods of time than IV push medications, which reduces the risks associated with rapid infusions, such as phlebitis and infiltration. In addition, some antibiotic medications are only stable for a limited time in solution. The secondary IV medication tubing is connected to the primary macrobore (large internal diameter) IV tubing and is therefore "secondary" to the primary infusion. The secondary solution bag is typically hung higher than the primary infusion bag and is subsequently "piggybacked" on top of the primary IV infusion. This higher position places greater gravitational pressure on the secondary IV solution. As a result, the primary infusion is temporarily paused until the secondary infusion volume has been delivered. This approach ensures that the medication is completely infused due to an immediate return of maintenance IV infusion in the IV line. The secondary IV infusion can be safely delivered when the patient's fluid volume status permits temporarily pausing the delivery of maintenance fluid and in hype

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 Science Education: Essentials of Nursing Skills

Discontinuing Intravenous Fluids and a Peripheral Intravenous Line

JoVE Science Education

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Intravenous (IV) fluid administration and peripheral IV catheters (PIVs) may be discontinued for a number of reasons. The most common reason for discontinuing IV fluids is that the patient has returned to normal body fluid volume (euvolemia) and is able to maintain adequate oral fluid intake or is being discharged from the hospital. In addition, the Centers for Disease Control Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011) recommends replacing PIVs every 72-96 h in adults to prevent the risk of infection or phlebitis. If the PIV becomes dislodged or if the insertion site demonstrates the signs and symptoms of infection, infiltration, extravasation, or phlebitis, the PIV should be discontinued and replaced. For pediatric patients, the Infusion Nurses Society recommends replacing the PIV only when the IV infusion site is no longer patent or when it demonstrates the signs and symptoms of complications. This video describes the approach to discontinue IV fluid administration and PIVs.

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 Science Education: Essentials of Lab Animal Research

Basic Care Procedures

JoVE Science Education

Source: Kay Stewart, RVT, RLATG, CMAR; Valerie A. Schroeder, RVT, RLATG. University of Notre Dame, IN

Mice and rats account for over 90% of the animals used for biomedical research. The proper care of these research animals is critical to the outcome of experiments. There are general procedures that apply to the majority of these mice and rats, but some of the animals, such as the immunocompromised ones, require additional steps to be taken to sustain them for experimentation. Commonly used immunocompromised mice include those that have naturally occurred in inbred mice and those that have been created through genetic engineering. The first immunocompromised mice used in research were "nude" mice. The BALB/c Nude (nu) mouse was discovered in 1966, within a BALB/c colony that was producing mice lacking both hair and a thymus. These athymic mice have an inhibited immune system that is devoid of T cells. The value of this animal was soon discovered for the use in studies of microbial infections, immune deficiencies, and autoimmunity. Although not as commonly used as the nude mouse, there is also a nude rat. The nude rat is T cell deficient and shows depleted cell populations in thymus-dependent areas of peripheral lymphoid organs. Another naturally occurring immune deficient mouse is the severe comb

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 Science Education: Essentials of Nursing Skills

Preparing and Administering Topical Medications

JoVE Science Education

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Topical medications are applied directly to the body surfaces, including the skin and mucous membranes of the eyes, ears, nose, vagina, and rectum. There are many classes of topical medications, such as creams, ointments, lotions, patches, and aerosol sprays. Medications that are applied to the skin to produce slow, controlled, systemic effect are also referred to as transdermal. Transdermal absorption can be altered if lesions, burns, or breakdowns are present at the application site. Many transdermal medications are delivered via adhesive patch to achieve the slow, controlled, systemic effect. The patch should be applied to clean and hairless skin areas that do not undergo excessive movement, such as the back of the shoulder or thigh. Other topical creams or eye ointments should be applied according to the packaging and manufacturer instructions using an application device. When instilling eardrop medications, never occlude the ear canal, as this may increase pressure and rupture the ear drum. Medications that can be administered via a topical route include antibiotics, narcotics, hormones, and even chemotherapeutics. This requires adherence to the five "rights" of medicati

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 Science Education: Essentials of Emergency Medicine and Critical Care

Percutaneous Cricothyrotomy

JoVE Science Education

Source: James W Bonz, MD, Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA

A surgical airway procedure is indicated when other forms of endotracheal intubation have failed and ventilation is worsening or not possible. This is the feared "can't intubate, can't ventilate" scenario, and in the emergency setting, cricothyrotomy is the surgical procedure of choice. Cricothyrotomy is preferred over tracheotomy because of the lower risk of complications, the predictable anatomy of the cricothyroid membrane, and the comparative rapidity with which the procedure can be performed—even by less experienced practitioners. Cricothyrotomy traditionally has been done in an "open" form; however, percutaneous cricothyrotomy using standard Seldinger technique has been advanced as a more successful approach when identification of the relevant anatomic landmarks is more difficult. Seldinger technique involves the introduction of a device into the body through the use of an introducer needle and a guide wire. The needle is used to locate the target; a guide wire is then fed through the thin-walled needle into the target, acting as a "placeholder" for the device, which is fed over the guide wire and into the target. In the cas

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 Science Education: Essentials of Nursing Skills

Preparing and Administering Subcutaneous Medications

JoVE Science Education

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Subcutaneous medication administration is a parenteral approach to administer small amounts of medication (less than 2 mL) into the layer of tissue just below the skin. Common medications administered via the subcutaneous route include anticoagulant medications, such as heparin or enoxaparin; epinephrine administered for allergic reactions; insulin; and some immunizations. Subcutaneous injection preparations are commonly provided in vials or ampules for withdrawal into a subcutaneous syringe. Subcutaneous needles have a shorter length and smaller diameter than syringes used for intramuscular injections, are typically less than 5/8th of an inch, and are 26 gauge or smaller. Medication absorption and onset is slower than for intravenous routes, with some absorption rates lasting 24 h or longer. This approach is selected for many medications that may be denatured or deactivated if given via the oral route, given the acidity of the gastrointestinal tract. Subcutaneous injection preparations are commonly provided in vials or ampules for withdrawal into a subcutaneous syringe. The nurse should determine the appropriate medication dose according to

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 JoVE Medicine

Evaluation of Cancer Stem Cell Migration Using Compartmentalizing Microfluidic Devices and Live Cell Imaging

1Department of Biomedical Engineering, University of Wisconsin-Madison, 2Materials Science Program, University of Wisconsin-Madison, 3Department of Neurological Surgery, University of Wisconsin-Madison, 4Carbone Comprehensive Cancer Center and Center for Stem Cell and Regenerative Medicine, University of Wisconsin-Madison


JoVE 3297

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 JoVE In-Press

A Wireless, Bidirectional Interface for in Vivo Recording and Stimulation of Neural Activity in Freely Behaving Rats

1Behavioral Neuroscience, Experimental and Biological Psychology, Philipps-Universität Marburg, 2Behavioral Neurosciences Institute (INeC), 3Thomas RECORDING GmbH, 4Department of Neurophysics, Philipps-Universität Marburg

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JoVE 56299

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 JoVE Medicine

Heterotopic Renal Autotransplantation in a Porcine Model: A Step-by-Step Protocol

1Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, 2Division of Nephrology, The Hospital for Sick Children, 3Programa de Doctorat en Medicina, La Universitat Autónoma de Barcelona, 4Laboratory Medicine and Pathobiology, Toronto General Hospital, 5Department of Medicine, Toronto General Hospital, 6Departments of Surgery (Urology) & Physiology, Developmental & Stem Cell Biology, The Hospital for Sick Children


JoVE 53765

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 JoVE In-Press

Creation and Transplantation of an Adipose-derived Stem Cell (ASC) Sheet in a Diabetic Wound-healing Model

1Diabetic Center, Tokyo Women's Medical University School of Medicine, 2The Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, 3The Department of Anatomy and Developmental Biology, Tokyo Women's Medical University School of Medicine

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JoVE 54539

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 Science Education: Essentials of Nursing Skills

Preparing and Administering Intramuscular Injections

JoVE Science Education

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Intramuscular (IM) injections deposit medications deep into the muscle tissue. Since muscle fibers are well perfused, this route of administration provides quick uptake of the medication and allows for the administration of relatively large volumes. Skeletal muscles have fewer pain-sensing nerves than subcutaneous tissue, which allows for the less painful administration of irritating drugs (e.g., chlorpromazine, an anti-psychotic). IM injections are recommended for patients unable to take oral medications and for uncooperative patients. Some examples of medications that are commonly delivered by IM injections include antibiotics, hormones, and vaccinations. As in any other route of administration, the nurse must consider if the medication is appropriate, given the patient's medical conditions, allergies, and current clinical status. In addition, specifically for IM injections, it is important to assess the patient's muscle mass to determine the appropriate needle size. Also, if the patient has already received this injection, it is necessary to verify the injection site that was previously used and to ensure that the previous dose did not result in any adverse

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 Science Education: Essentials of Nursing Skills

Initiating Maintenance IV Fluids

JoVE Science Education

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Hospitalized patients frequently require the administration of intravenous (IV) fluids to maintain their fluid and electrolyte balance. Certain medical conditions that preclude oral fluid intake may necessitate IV fluid administration, with or without electrolytes, to prevent hypovolemia, dehydration, and electrolyte imbalances. Pre-surgical and pre-procedure patients who require anesthesia are often required to be NPO (i.e., nil per os; Latin for "nothing by mouth") to prevent aspiration and to maintain hydration during the procedure. Post-surgical and post-procedure patients may also require IV fluid administration to increase intravascular volume following surgical blood loss. IV fluids can be delivered by different types of administrations sets: gravity flow infusion devices, which rely on gravitation force to push the fluid to the patient's bloodstream, or infusion pumps, which use a pump mechanism that generates positive pressure. While administering maintenance IV fluids using an infusion pump is the most common approach, facility policy; availability of infusion pump equipment; and other limitations, such as a power outage, may necessitate the use of IV gravity tub

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 JoVE Medicine

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

1Keck School of Medicine, University of Southern California, 2Psoriasis and Skin Treatment Center Dermatology, University of California, San Francisco, 3University of California Irvine School of Medicine, 4University of Arizona College of Medicine, 5Chicago College of Osteopathic Medicine


JoVE 50509

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