Valsalva maneuver

Kiwi, BSN, RN · Mar 25, 2006

Well, first you lift up the seat. Gather mentally-stimulating reading material. Sit down. Take a deep cleansing breath, prepare yourself, and go at it..........

j/k

Just hold lips together and blow without air escaping from nostrils. That is about as easy as the description can get. Remember to use care with pregnant women with respect to the VM.

MmacFN · Mar 25, 2006

LOL

Ok under what circumastances? On patients intubated or not?

sandman1 · Mar 25, 2006

Turn off the vent, close the APL valve, turn up the gas flow, squeeze the bag until you reach your predetermined pressure (40 is a nice number) and hold it.

MmacFN · Mar 25, 2006

yup

When i am doing a central line (subclavian specifically) i will valsalva my patient by holding in a breath (bagging) in order to dilate the subclavian vein and make it easier. Works very well. I actually have ultrasound pics of my own i used to demonstrate the difference

athomas91 · Mar 26, 2006

a few years ago - FN's weren't sanctioned to do centrals - i knew they were thinking about changing that - when did it happen??

MmacFN · Mar 26, 2006

central lines?

That might be state specific. Air Evac Services here in AZ has been doing them for 37 years. I also learned to do them when i was a paramedic years ago.

I currently teach sub-clavians, internal jugulars & femorals to our new flight nurses and medics. Honestly, central lines are not done often in the field, nor should they be. I teach them as a last resort. In truth, with the advent of the EZ-IO drill, its hard to justify them at all.

The learning curve for central lines is high for new people, but i could teach an ez io to a non-medical person in less than 20 minutes. The risks of central lines are high whereas those with the EZ IO are minimal.

Its an awesome device!

SuesquatchRN, BSN, RN · Mar 26, 2006

I had no idea this applied to anything but pooping. :confused:

MmacFN · Mar 26, 2006

LOL

Well, when you valsalva the mechanism (a Parasympathetic one) causes dilation of the veins and arteries as well as a depression of the SA node (causing bradycardia).

In anycase, this dilation makes placing central lines much easier. I tried to attached pics of pre and post valsalva of my own internal juglar (ultrasound pics), but they are too big for the forum. If your interested let me know and ill send them to you

I had no idea this applied to anything but pooping.

SuesquatchRN, BSN, RN · Mar 26, 2006

Thanks, Mike. It's good to know that that fancy=schmancy name for holding your breath and pushing is good for something else!

MmacFN · Mar 26, 2006

heheh too true!

maturner · Mar 26, 2006

LOL
Well, when you valsalva the mechanism (a Parasympathetic one) causes dilation of the veins and arteries as well as a depression of the SA node (causing bradycardia).
In anycase, this dilation makes placing central lines much easier. I tried to attached pics of pre and post valsalva of my own internal juglar (ultrasound pics), but they are too big for the forum. If your interested let me know and ill send them to you

The valsalva in anesthesia is actually generally applied during spinal cases to confirm that the dura has not been punctured or that the closure of dura is complete after it was intentionally opened.

The pop off valve is closed and an inspiratory pressure of about 30 is held while the surgeon inspects the integrity of the dura.

The increased thoracic pressure decreases venous return-> increasing venous dilation within the brain-> increased icp-> deceased CSF in cranial vault-> increased CSF in spinal column-> dural stretch = leak or no leak.

Several other physiologic responses occur as a result of a valsalva; however, in anesthesia the above is the response for which we are generally looking.