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.

Training of Undergraduate Clinicians in Vascular Access: An Integrative Review

2012 ◽  
Vol 17 (3) ◽  
pp. 146-158 ◽  
Author(s):  
Evan Alexandrou ◽  
Lucie Ramjan ◽  
Jeff Murphy ◽  
Leanne Hunt ◽  
Vasiliki Betihavas ◽  
...  
Keyword(s):  
Skill Acquisition ◽  
Vascular Access ◽  
Search Strategy ◽  
Venous Access ◽  
Training Methods ◽  
Design Studies ◽  
Medical Practitioners ◽  
Staff Members ◽  
Methodologic Quality ◽  
Peripheral Venous Access

Abstract Introduction: Peripheral venous cannulas are predominantly inserted by nurses and medical practitioners. Placement and related care of such devices are one of the most frequently performed tasks by these staff members. Clinicians in training should be given ample opportunity to practice these skills before patient encounters begin. Aims: To identify the best available evidence on the training of undergraduate clinicians in peripheral venous access. Methods: We used an integrative literature review method that considered both experimental- and nonexperimental-design studies that addressed the issue of clinician peripheral venous access training of undergraduates. The electronic databases Medline, Embase, Ovid Nursing Database, British Nursing Index, Pre Medline, Mosby's Index, and CINAHL were searched using a predetermined search strategy. The Cochrane and Joanna Briggs databases were also searched along with the reference lists of published materials. Results: A total of 56 articles were retrieved using the defined search strategy. There were 11 experimental-design studies and 1 nonexperimental-design study selected for final review after independent assessment for methodologic quality. Retrieved articles found disparity between actual skill and student self-evaluation. Teaching methods varied with the use of traditional task trainers and high-fidelity simulation. No method was found to be superior. Conclusion: Skill acquisition in vascular access is an international issue and one that has been addressed in varying degrees. We identified heterogeneity in training methods that were tailored to institutional requirements and resources. Training in this skill is imperative to ensure competency before patient encounters.

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.

Totally Implantable Venous Access Ports Systems for Patients Receiving Chemotherapy for Solid Tissue Malignancies: A Randomized Controlled Clinical Trial Examining the Safety, Efficacy, Costs, and Impact on Quality of Life

1999 ◽  
Vol 17 (4) ◽  
pp. 1267-1267 ◽  
Author(s):  
Eric J. Bow ◽  
Marilyn G. Kilpatrick ◽  
Jennifer J. Clinch
Keyword(s):  
Quality Of Life ◽  
Central Venous Access ◽  
Venous Access ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Complication Rates ◽  
Access Port ◽  
Functional Quality ◽  
Peripheral Venous Access

PURPOSE: To examine the safety, efficacy, costs, and impact on quality of life of venous access ports implanted at the outset of a course of intravenous cancer chemotherapy. PATIENTS AND METHODS: Adults beginning a course of intravenous chemotherapy at two university-affiliated hospitals were randomly allocated to have venous access using a surgically implanted venous access port (Port-a-Cath; Pharmacia, Canada Inc, Montreal, Québec, Canada) or using standard peripheral venous access. All accesses were documented by number, route, purpose, and procedure duration. Outcome measurements included port complications, access strategy failure, access-related anxiety and pain, quality of life (Functional Living Index–Cancer [FLI-C]), and costs. RESULTS: Port complication rates were low (0.23/1,000 days). Failure occurred in two (3.4%) of 59 port subjects and 16 (26.7%) of 60 controls (P = .0004) at a median period of 26 days after randomization (95% confidence interval, 8 to 92). Peripheral accesses in port subjects took less time, had less access-related anxiety and pain, and were less costly to perform than in controls. Allocation had no effect on FLI-C scores. Peripheral access failure correlated with allocation to the control group (P = .007), higher pain scores with intravenous (IV) starts (P = .003), and anxiety with IV starts (P = .01). Venous accessing overall in port patients was four times more costly than that in controls ($2,178/patient v $530/patient, respectively). CONCLUSION: Ports were safe and effective but had no detectable impact on functional quality of life, despite less access-related anxiety, pain, and discomfort. Because only approximately one quarter of control patients ultimately required central venous access, economic considerations suggest that port-use policies should be based upon defined criteria of need.

scholarly journals Preliminary experience on subcutaneous venous access device (chemoport) in a teaching hospital in Kathmandu

2016 ◽  
Vol 4 (2) ◽  
pp. 50-54
Author(s):  
Robin Joshi
Keyword(s):  
Venous Access ◽  
Late Complications ◽  
Urinary Bladder Carcinoma ◽  
Complication Rates ◽  
Major Life ◽  
Access Device ◽  
Medical College ◽  
Peripheral Venous Access ◽  
Ultrasound Guided Puncture ◽  
Venous Access Device

Background: Modern subcutaneous venous access device or chemo port nowadays is a vital device used in case of chronic diseases. It is now an established device for administration of medication and blood withdrawal without difficulty and negating repeated skin punctures for those patients who need repeated and long term intravenous medication. But, these devices are not without complications.Objective: To assess preliminary technical success and complication rates of the ultrasound and fluoroscopy guided placement of subcutaneous venous access device.Methods: Between November 2012 to May 2015, 10 port catheter components were implanted. All components were inserted under image guidance. Ultrasound guided puncture of right internal jugular vein was preferred and position of tip of catheter was confirmed by fluoroscopy. Early and late complications were evaluated. The overall cost of the chemo port was also taken into consideration.Results: The implantation was inserted in ten cases. Four patients had ovarian carcinoma, three patients metastatic colonic carcinoma, one had testicular cancer with meditational mass, one patient had metastatic invasive urinary bladder carcinoma and another one had porphyries whose peripheral venous access were all thromboses due to repeated puncture. Peri-procedural early complications like blockage, thrombosis, leak were not observed, however one patient had catheter related fever. Late complications like blockage, port, fractures, dislodgement, venous thrombosis were also not found but One patient had port pocket infection. The cost of the port device in all cases was about 50,000 Nepalese rupees.Conclusion: Larger number of case is required for better statistical evaluation. The main reason for the refusal of subcutaneous venous access device insertion by the patients was the high cost of the device. Cather-related morbidity was in acceptable range so chemo port insertion is feasible in Nepal. Major life threatening complication was not observed.Journal of Kathmandu Medical College, Vol. 4, No. 2, Issue 12, Apr.-Jun., 2015

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 Hospitalized children’s opinions about peripheral venous access process (PVAP)

2018 ◽  
Vol 15 (1) ◽  
pp. 243
Author(s):  
Nazan Çakırer Çalbayram ◽  
Sebahat Altundağ
Keyword(s):  
Vascular Access ◽  
Primary Caregivers ◽  
Research Problem ◽  
Venous Access ◽  
Structured Interview ◽  
Interview Method ◽  
Peripheral Venous Access ◽  
Qualitative Descriptive ◽  
The Universe ◽  
Process Method

Research problem/aim: This study was carried out to determine the thoughts of school-age (6-12 years old) children about peripheral venous access process. Method: The study was carried out in qualitative descriptive design using semi-structured interview method. The universe of the study was composed of children aged between 6 and 12 hospitalized in the aforementioned hospital. Findings: The children who were informed before the process said the warnings were, “take a deep breath, don’t move your hand, calm down”. The children reported that they felt “excitement, sadness, pain, and fear” while the vascular access intervention was being performed. It was observed that the children had many negative emotions and experiences about vascular access process. Conclusions: Children may need both physical and psychological support for invasive process, such as vascular access process. Nurses as primary caregivers should give this support to children.

scholarly journals Problems Associated with Vascular Access: An Analysis of 2000 Incident Reports

1993 ◽  
Vol 21 (5) ◽  
pp. 664-669 ◽  
Author(s):  
R. J. Singleton ◽  
R. K. Webb ◽  
G. L. Ludbrook ◽  
M. A. L. Fox
Keyword(s):  
Vascular Access ◽  
Vascular System ◽  
Central Venous Access ◽  
Blood Pressure Measurement ◽  
Air Embolism ◽  
Venous Access ◽  
Arterial Line ◽  
X Rays ◽  
Peripheral Venous Access ◽  
Peripheral Arterial

There were 65 incidents involving access to the vascular system amongst the first 2000 reported to the Australian Incident Monitoring Study. Thirty-three involved peripheral venous access (14 cases of extravascular extravasation, 8 of unintended arterial cannulation, 6 of disruptions to intravenous lines, and 5 of problems with infusion lines, taps, pumps and connectors). Eighteen cases involved central venous access (9 cases of arterial puncture with haematomas, 5 with morbidity and/or prolonged admission), 5 of catheter misplacement and pneumo- or hydro-thorax and 4 of problems arising from operator inexperience. Thirteen cases involved peripheral arterial acces (5 involved equipment problems (3 with possible air embolism), 3 of mistaking an arterial for a venous line (drugs were injected in 2), 3 of losing arterial lines or signals, and 2 in which the presence of an arterial line placed the patient at risk). The anaesthetist should always question the continued integrity of any vascular access system, even when it has recently been shown to be functioning, and the possibility of later “migration” and misplacement should always be borne in mind. Whenever possible, correct placement of the tip should be checked (e.g. by visual inspection of the site, use of test doses, aspiration of blood, pressure measurement, X-rays). When there is more than one line, all lines and sites of access (e.g. 3-way taps) should be clearly labelled and checked before anything is injected or infused.

Long peripheral catheters and midline catheters: Insights from a survey of vascular access specialists

2020 ◽  
pp. 112972982096622 ◽  
Author(s):  
Kirby R Qin ◽  
Mauro Pittiruti ◽  
Ramesh M Nataraja ◽  
Maurizio Pacilli
Keyword(s):  
Vascular Access ◽  
Venous Access ◽  
Common Indication ◽  
Electronic Survey ◽  
Peripheral Venous Access ◽  
General Recommendation ◽  
Peripheral Intravenous Access ◽  
Intravenous Catheters ◽  
Difficult Venous Access

Background: Peripheral intravenous access is no longer limited to the standard intravenous catheter (cannula). Devices varying in length, material and insertion technique, are increasingly accessible. There is substantial variability surrounding the nomenclature and use of these devices in the literature. We wished to understand the attitude of vascular access specialists towards the nomenclature and use of peripheral intravenous catheters (PIVCs), long peripheral catheters (LPCs) and midline catheters (MCs). Methods: A 15-question electronic survey was sent to members of the Association of Vascular Access (AVA) regarding the nomenclature and use of PIVCs, LPCs and MCs. Results: A total of 228 participants completed the survey. Approximately two-thirds of respondents use LPCs (65.8%) and MCs (71.9%) in their clinical practice. The most common indication for LPCs was difficult venous access (56.5%), while the most common indication for MCs was medium-term (1–4 weeks) intravenous therapy (62.7%). The majority of participants (57.9%) agreed with the following classification of peripheral intravenous devices: PIVCs: 2 to 6 cm in length, terminating distal to the axilla; LPCs: 6 to 15 cm in length, terminating distal to the axilla; MCs: 15–25 cm in length, terminating in the axilla. Participants suggested that the length of the catheter should be considered a general recommendation, as LPCs and MCs should be primarily differentiated by tip location. Conclusions: The majority of vascular access specialists from AVA have incorporated LPCs and MCs into their repertoire of peripheral venous access tools. We envisage that their use will increase as the clinical community becomes more familiar with these devices.

Emergency Vascular Access (DRAFT)

2018 ◽  
Author(s):  
Rajagopala Padmanabhan ◽  
Holt N. Murray
Keyword(s):  
Critically Ill ◽  
Vascular Access ◽  
Critically Ill Patients ◽  
Rapid Response Team ◽  
Venous Access ◽  
Critically Ill Patient ◽  
Blood Products ◽  
Life Saving ◽  
Peripheral Venous Access ◽  
Response Team

Emergency resuscitation and stabilization of the critically ill patient is a cornerstone of patient care during a rapid response team (RRT) call. The establishment of vascular access, along with airway, breathing, and circulation management is pivotal for the delivery of fluid, blood products, and life-saving medications that can directly impact the morbidity and mortality of critically ill patients. Unfortunately, peripheral venous access may be difficult, if not impossible, to get in some patients. In these, and other select situations, excess time spent attempting to insert a peripheral line can delay essential therapies. In this chapter, the indications, types, and methods of establishing vascular access will be reviewed briefly.

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