Vascular access

2020 ◽  
pp. 43-69
Author(s):  
Andrew Mitchell ◽  
Giovanni Luigi De Maria ◽  
Adrian Banning
Keyword(s):  
Cardiac Catheterization ◽  
Vascular Access ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Venous Access ◽  
Seldinger Technique ◽  
Access Route ◽  
Arterial Access ◽  
Alternative Approach ◽  
Different Types

This chapter discusses different types of vascular access in cardiac catheterization. It starts by describing the Seldinger technique, then goes on to explain which arterial access route to use, including difficulties and reasons for choosing an alternative approach and trends in vascular access. The ways of obtaining arterial access (both radial and femoral) are covered, and venous access is examined for the femoral, internal jugular, and subclavian veins. Anticoagulation issues including warfarin and direct oral anticoagulants are then discussed, and the chapter ends by describing compression devices and arterial closure devices.

Periprocedural anticoagulation management in edxoaban patients undergoing catheter-based cardiovascular procedures: analyses of the noninterventional global EMIT study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Vanassche ◽  
P Colonna ◽  
A Santamaria ◽  
C Chen ◽  
C Von Heymann ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Venous Access ◽  
Private Company ◽  
Arterial Access ◽  
Periprocedural Management ◽  
Clinical Events ◽  
Post Procedure ◽  
Baseline Characteristics

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Background  The optimal periprocedural management of direct oral anticoagulants (DOAC), including edoxaban, in patients undergoing catheter-based cardiovascular procedures is unknown, and mainly based on physician opinion and experience. Purpose To assess real-world management of edoxaban in patients undergoing cardiovascular procedures, and to report their clinical events. Methods Global EMIT-AF/VTE is a prospective study of periprocedural management in edoxaban-treated patients undergoing diagnostic and therapeutic procedures. We report the data from patients undergoing cardiovascular procedures. Timing and duration of edoxaban interruption were at the treating physician’s discretion. Outcomes were collected from 5 days before until 30 days post procedure. Primary outcome was the incidence of major bleeding (MB); secondary outcomes included incidence of clinically relevant non-major bleeding (CRNMB) and acute thromboembolic events (ATE). Results Data was collected from 301 and 311 procedures with arterial or venous access, respectively. Baseline characteristics are shown in Table 1. Edoxaban was not interrupted in 36.9% of arterial and 52.7% of venous procedures. Edoxaban was interrupted pre-procedure in 41% of arterial and 32.8% of venous procedures. The median periprocedural interruption was 2 days. The overall incidence of bleeding was very low. Any bleeding was reported in 8 patients undergoing arterial and 10 patients undergoing venous procedures (2.7% and 3.2%). MB or CRNMB occurred in 2 arterial and 3 venous procedures (0.7% and 1.0%) and ATE occurred in 5 arterial and 1 venous procedure (1.7% and 0.3%, Table 1). Conclusions In this study, the periprocedural risks of bleeding and thrombotic events were low. About a third of arterial access procedures and half of venous access procedures were performed without edoxaban interruption. Arterial(n = 301) Venous(n = 311) Baseline characteristics Age, year, mean (SD)Male, n (%)Weight (kg), mean (SD) 71.9 (8.5)211 (70.1%)80.8 (16.7) 64.6 (11.1)215 (69.1%)84.1 (17.4) CrCL (mL/min), mean (SD) CHA2DS2-VASc score, mean (SD)HAS-BLED score, mean (SD) 73.5 (29.8) 3.3 (1.5)2.0 (1.0) 88.9 (35.5) 2.2 (1.5)1.3 (1.0) Edoxaban 60 mg / 30 mg, % 73% / 26% 88% / 26% Coronary heart disease, n (%) Congestive heart failure, n (%) 101 (33.6%) 58 (19.3%) 51 (16.4%) 33 (10.6%) Interruption of edoxaban, n (%) No interruption Pre-procedure only Post-procedure only Pre- and post-procedure 111 (36.9%)125 (41.5%)12 (4.0%)53 (17.6%) 164 (52.7%)102 (32.8%)8 (2.6%)37 (11.9%) Clinical events, n (%) MB or CRNMBACSStroke/Transient ischemic attackCV mortalityAll-cause mortality 2 (0.7%)2 (0.7%)3 (1.0%)1 (0.3%)2 (0.7%) 3 (1.0%) 01 (0.3%)00

scholarly journals Treatment of venous thromboembolism in pediatric patients

Blood ◽  
2020 ◽  
Vol 135 (5) ◽  
pp. 335-343 ◽  
Author(s):  
Char Witmer ◽  
Leslie Raffini
Keyword(s):  
Clinical Trials ◽  
Venous Thromboembolism ◽  
Randomized Clinical Trials ◽  
Central Venous Access ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Venous Access ◽  
Renal Vein Thrombosis ◽  
Healthy Children ◽  
Vein Thrombosis

Abstract Venous thromboembolism (VTE) is rare in healthy children, but is an increasing problem in children with underlying medical conditions. Pediatric VTE encompasses a highly heterogenous population, with variation in age, thrombosis location, and underlying medical comorbidities. Evidence from pediatric clinical trials to guide treatment of VTE is lacking so treatment is often extrapolated from adult trials and expert consensus opinion. Aspects unique to children include developmental hemostasis and the major role of central venous access devices. There is an absence of information regarding the optimal target levels of anticoagulation for neonates and infants and lack of suitable drug formulations. Anticoagulants, primarily low-molecular-weight heparin and warfarin, are used to treat children with symptomatic VTE. These drugs have significant limitations, including the need for subcutaneous injections and frequent monitoring. Randomized clinical trials of direct oral anticoagulants in pediatric VTE are ongoing, with results anticipated soon. These trials will provide new evidence and options for therapy that have the potential to improve care. International collaborative registries offer the ability to study outcomes of rare subgroups of pediatric VTE (eg, renal vein thrombosis), and will be important to ultimately guide therapy in a more disease-specific manner.

scholarly journals Comparison of HemoFoam® and Conventional Gauze Dressing on Hemostasis of Vascular Access Site in Hemodialysis Patients

2019 ◽  
Vol 8 ◽  
pp. 1395
Author(s):  
Davood Bizari ◽  
Hadi Khoshmohabat ◽  
Soheila Salahshour Kordestani ◽  
Rouhollah Zarepur
Keyword(s):  
Vascular Access ◽  
Venous Access ◽  
Hemodialysis Patients ◽  
Dialysis Access ◽  
Access Site ◽  
Puncture Wound ◽  
Arterial Access ◽  
Gauze Dressing ◽  
The Mean ◽  
Venous Access Site

Background: Dialysis access puncture wound bleeding after needle extraction at the end of each hemodialysis session is a very important problem. This study evaluated the effect of HemoFoam® compared to conventional gauze dressing on hemostasis of dialysis access puncture wound bleeding in hemodialysis patients. Materials and Methods: This one-group, before-after, clinical-trial was conducted on 60 hemodialysis patients selected by convenience sampling who underwent hemodialysis through arteriovenous fistula in Shahid Rahnemoon Hospital, Yazd, Iran in 2017. After reviewing the eligibility criteria, the study was performed in two separate sessions. In the first session, only HemoFoam® was used while in the second session; the only conventional dressing was used. Time of hemostasis in each puncture wound was evaluated. Data were analyzed by SPSS 22 (IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp, United States) using paired T-test and Chi-square tests. Results: The mean age of the patients was 55.20±14.25 years. Hemostasis was achieved in 76.6% of cases at the arterial access site in the first two minutes in the HemoFoam® group. The mean homeostasis time in the HemoFoam® group was 2.86±1.87 min at the venous access site and 3.15±1.97 min at the arterial access site (P<0.001). The mean homeostasis time in the conventional dressing group was 10.54±6.65 min at venous access site and 12.74±9.28 min at the arterial access site, which was significantly different between the two groups (P<0.001). Conclusion: HemoFoam® is effective in reducing the time of homeostasis in the vascular access site of hemodialysis patients. Therefore, its use in hemodialysis wards is recommended for hemostasis in the dialysis access puncture wound bleeding. [GMJ.2019;8:e1395]

scholarly journals Ultrasound-Guided Vascular Access Is an Important Tool to Prevent Catastrophes: Transinferior Epigastric Artery Cardiac Catheterization

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Ahmed Amro ◽  
Kanaan Mansoor ◽  
Mohammad Amro ◽  
Amal Sobeih ◽  
Rameez Sayyed
Keyword(s):  
Cardiac Catheterization ◽  
Vascular Access ◽  
Inferior Epigastric Artery ◽  
First Line ◽  
Arterial Access ◽  
Epigastric Artery ◽  
History Of ◽  
To Come ◽  
Catheterization Procedure ◽  
Line Standard

We report a case of cardiac catheterization that was done entirely by accidentally accessing the inferior epigastric artery (IEA) through an unintentional puncture of the U-shaped portion of the inferior epigastric artery. Luckily the patient did not have any trauma to the IEA and was d/c home with no complications. A 48-year-old female with history of hypertension and CAD S/P left circumflex stent many years ago who presented to our facility with persistent crescendo angina for which decision was made to proceed with LHC. The cardiac catheterization showed no significant CAD with patent stent so it was decided that there is no further intervention needed. Femoral angiogram was done and showed that the stick was high and the tip of the sheath was about to come out of the CFA; at the same time, it came into our minds that the sheath could be passing through the IEA by sticking the U portion of the IEA, but due to the high risk, an immediate access was obtained through the contralateral groin then a balloon over the wire was passed beyond the original sheath tip, then the sheath was slowly pulled back while contrast was injected. Angiogram showed that the sheath was inserted through the U-shaped portion of the IEA. Conclusion. Ultrasound guidance should be the first-line standard for arterial access in any cardiac catheterization procedure. US is a proven tool that can increase success and decrease complications in a wide variety of vascular access procedures.

scholarly journals Direct oral anticoagulants and the risk of osteoporotic fractures in patients with non-valvular atrial fibrillation

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110113
Author(s):  
Liang-Tseng Kuo ◽  
Su-Ju Lin ◽  
Victor Chien-Chia Wu ◽  
Jung-Jung Chang ◽  
Pao-Hsien Chu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hip Fracture ◽  
Osteoporotic Fracture ◽  
Low Dose ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Osteoporotic Fractures ◽  
Different Types ◽  
History Of ◽  
Artery Disease

Background: The incidence of osteoporotic fracture increases with age, particularly in elderly populations with atrial fibrillation (AF). However, direct oral anticoagulants (DOACs) have less effect on osteoporotic fracture than vitamin K antagonists, it is unclear whether the risk of osteoporotic fracture is affected by different types and doses of DOACs in AF patients. Methods: This nationwide population-based cohort study included AF patients prescribed DOACs between 2011 and 2016 taken from the Taiwan National Health Insurance database. Adjusted hazard ratios (aHRs) for the risk of osteoporotic, hip, and spine fractures between DOAC users were compared using the Fine and Gray subdistribution hazard model to adjust for possible confounders. Results: A total of 56,795 patients who were prescribed DOACs were included in the present study. Among them, 24,597 patients received dabigatran, 26,968 received rivaroxaban, and 5230 received apixaban. After 2 years’ follow up, there was no significant difference in the incidence of osteoporotic, spine, or hip fracture among those receiving dabigatran, rivaroxaban, or apixaban. Subgroup analysis showed that patients taking dabigatran had a higher incidence of osteoporotic and hip fracture than those taking rivaroxaban and apixaban in cases with concomitant peripheral artery disease (PAD) or a history of hip fracture ( p for interaction: 0.004 and 0.030, respectively). However, dabigatran users had a lower incidence of osteoporotic fracture and spine fracture in those receiving standard-dose DOACs compared with rivaroxaban and apixaban; whereas, they had a higher incidence of hip fractures when administered at low dose. Conclusion: AF patients with different DOACs did not have different risks of osteoporotic fracture overall. However, additional concomitant morbidities, such as PAD or a history of hip fracture, and standard/low doses might be associated with different risks for different DOACs. These findings should be taken into consideration in the clinic when the DOAC is being chosen. Plain language summary Different direct oral anticoagulants had different impact on osteoporotic fracture Anticoagulation therapy is an essential therapy in atrial fibrillation (AF) patients, but osteoporotic fracture is another important issue in these patients prescribed with anticoagulants. However, no study has been conducted to evaluate the impact of different DOACs on different types of osteoporotic fractures. In our findings, although different DOACs had no significantly different impact on osteoporotic fractures, dabigatran users had a slightly higher incidence of osteoporotic and hip fractures among different DOACs, particularly in those have simultaneously had peripheral artery disease, a history of hip fracture. In addition, when AF patients taking low-dose DOACs, dabigatran users also have higher incidence of hip fracture than those taking other DOACs.

The case for using implanted ports

2019 ◽  
Vol 28 (Sup14a) ◽  
pp. S3-S10 ◽  
Author(s):  
Jane Hodson
Keyword(s):  
Bloodstream Infection ◽  
Vascular Access ◽  
Central Venous Access ◽  
Venous Access ◽  
Low Risk ◽  
Central Venous ◽  
Different Types ◽  
Venous Access Devices ◽  
Catheter Related Bloodstream Infection

Uses of central venous access devices (CVADs) include the administration of vital fluids and medications. Implanted ports are a type of CVAD that is used when long-term vascular access is required. The device is discreet and associated with a low risk of catheter-related bloodstream infection. This article describes the different types and components of ports and how to select them. It explains how to insert ports, and provides guidance on accessing and de-accessing them

Ultrasound-guided vascular access in intensive/acute cardiac care

2015 ◽  
Author(s):  
Richard Paul
Keyword(s):  
Vascular Access ◽  
Posterior Wall ◽  
Venous Access ◽  
Cardiac Care ◽  
Complication Rates ◽  
International Consensus ◽  
Arterial Access ◽  
Fluid Delivery ◽  
Peripheral Venous Access ◽  
Acute Cardiac Care

Vascular access is an essential requirement for the care of the critically ill cardiac patient, being necessary for drug and fluid delivery and monitoring of a patient’s haemodynamic response to an instigated therapy. The most common vascular access procedures conducted in the acute cardiac care unit are central venous and peripheral venous access, and arterial cannulation. Traditional landmark methods are associated with complication rates, ranging from 18 to 40%, depending on the site of access. The use of ultrasound to guide venous and arterial access has been shown to reduce the incidence of complications, such as inadvertent arterial puncture and pneumothorax formation (venous) and posterior wall puncture (arterial), to reduce the time taken and number of attempts to place a catheter, and to reduce the incidence of complete failure to insert a vascular access device. Since 2002, international consensus groups have published recommendations that two-dimensional ultrasound guidance be the preferred method for elective and emergency internal jugular catheter insertion. This chapter explores the evidence for the use of ultrasound to guide vascular access across multiple sites of insertion and describes the basic equipment and techniques necessary for successful deployment.

Arterial and Venous Access

2018 ◽  
pp. 114-125
Author(s):  
Alexandra H. Fairchild ◽  
Robert A. Hieb
Keyword(s):  
Vascular Access ◽  
Endovascular Therapy ◽  
Interventional Procedures ◽  
Venous Access ◽  
Bypass Grafts ◽  
Percutaneous Approach ◽  
Critical Part ◽  
Arterial Access ◽  
Pros And Cons ◽  
Access Complications

Vascular access is a critical part of endovascular therapy. Vascular access complications continue to represent a significant amount of morbidity and mortality related to endovascular procedures. This chapter introduces the topic of arterial access—a critical step in many interventional procedures. The ideal arterial access has a simple, percutaneous approach and a low risk of complications, is of the appropriate caliber to accommodate the sheath size for the procedure, and allows easy control of the vessel. The pros and cons of the various access sites for specific procedures are reviewed. Anatomy and access techniques of both common (e.g., femoral, radial, and brachial arteries) and less common access vessels (e.g., tibiopedal vessels, bypass grafts) are discussed in detail. A review of options to achieve hemostasis following arterial access and potential access site complications is also included. Finally, a brief discussion of venous access for visceral interventions is included.

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