A triple tunnel from the mid-calf to the femoral vein in patient with severe dementia

2021 ◽  
pp. 112972982110268
Author(s):  
Matthew Ostroff ◽  
Nagwa Hafez ◽  
Toni Ann Weite
Keyword(s):  
Vascular Access ◽  
Femoral Vein ◽  
Venous Access ◽  
Exit Site ◽  
Severe Dementia ◽  
Femoral Catheter ◽  
Scapular Region ◽  
The Ideal

Achieving the ideal exit site is the new philosophy for complicated vascular access patients. Recent publications have described multiple venous access solutions such as tunneling to the scapular region, the chest to the arm, and from the femoral vein to the abdominal and patellar region. In the patients afflicted with delirium, dementia, or confusion even these sites may not be sufficient. The following case study illustrates a triple tunneled femoral catheter on a non-cooperative patient with inoperable endocarditis to be discharged and treated with long term antibiotics.

Rapid Assessment of Vascular Exit Site and Tunneling Options (RAVESTO): A new decision tool in the management of the complex vascular access patients

2021 ◽  
pp. 112972982110343
Author(s):  
Matthew D Ostroff ◽  
Nancy Moureau ◽  
Mauro Pittiruti
Keyword(s):  
Vascular Access ◽  
Femoral Vein ◽  
Central Venous Access ◽  
Rapid Assessment ◽  
Venous Access ◽  
Central Vein ◽  
Exit Site ◽  
Central Venous ◽  
Venous Catheterization ◽  
Subcutaneous Tunneling

In the last decade, different standardized protocols have been developed for a systematic ultrasound venous assessment before central venous catheterization: RaCeVA (Rapid Central Vein Assessment), RaPeVA (Rapid Peripheral Vein Assessment), and RaFeVA (Rapid Femoral Vein Assessment). Such protocols were designed to locate the ideal puncture site to minimize insertion-related complications. Recently, subcutaneous tunneling of non-cuffed central venous access devices at bedside has also grown in acceptance. The main rationale for tunneling is to relocate the exit site based on patient factors and concerns for dislodgement. The tool we describe (RAVESTO—Rapid Assessment of Vascular Exit Site and Tunneling Options) defines the different options of subcutaneous tunneling and their indications in different clinical situations in patients with complex vascular access.

Advanced vascular access

2019 ◽  
pp. 177-190
Author(s):  
Richard Craig
Keyword(s):  
Vascular Access ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Short Term ◽  
Central Lines ◽  
Venous Access Devices

In this chapter, the use of ultrasound to facilitate cannulation of a vessel is described in detail, including commentaries on equipment, preparation, scanning, and needling technique. Equipment and techniques for the insertion of short-term non-tunnelled central lines, long-term central venous access devices, arterial lines, and intraosseous needles are presented.

Simultaneous placement of leadless pacemaker and dialysis catheter in patient with exhausted vasculature

2019 ◽  
pp. 112972981989408
Author(s):  
Dawid Bednarczyk ◽  
Wiktor Kuliczkowski ◽  
Krzysztof Letachowicz ◽  
Marcin Dzidowski ◽  
Tomasz Witkowski ◽  
...  
Keyword(s):  
Vascular Access ◽  
Electronic Device ◽  
Cardiac Pacemaker ◽  
Cardiac Pacing ◽  
Venous Access ◽  
Cardiac Implantable Electronic Device ◽  
Leadless Pacemaker ◽  
Access Problem ◽  
Arteriovenous Access

The problem with limited venous access may occur in patients receiving long-term hemodialysis treatment with no possibility of arteriovenous access or in patients with cardiac implantable electronic device–related infection leading to the removal of cardiac implantable electronic device. We present a case report where both situations occur simultaneously. Using recent development in cardiac pacing—leadless cardiac pacemaker—we manage to overcome the vascular access problem. The described case emphasizes the necessity of multispecialty collaboration and gains of new pacing technology in patients who need placement of vascular access for hemodialysis and cardiac implantable electronic device where vascular access is scarce.

Femoral Positioning of Tesio Catheters for Hemodialysis

2000 ◽  
Vol 1 (2) ◽  
pp. 60-65 ◽  
Author(s):  
M. Pecorari
Keyword(s):  
Blood Flow ◽  
Vascular Access ◽  
Femoral Vein ◽  
Crucial Importance ◽  
Vascular Access Devices ◽  
Alternative Site

Vascular access may be of crucial importance in long-term dialyzed patients when traditional blood access fails. Long-term central vascular access devices are usually inserted in the internal jugular or subclavian veins but thrombosis may be the major factor limiting their long-term use. To solve this problem the Tesio caheter is one of the most commonly recommended tools for long-term use in RD patients, and is normally placed in the neck veins. In this study the femoral vein is indicated as an alternative site for positioning the Tesio catheter. The “high” exit (abdominal) reported here presents some advantages for the patient who can then walk without difficulties while maintaining a high blood flow that is similar to those achieved with catheters implanted in other sites.

Long-term femoral vein central venous access in cancer patients

1996 ◽  
Vol 22 (2) ◽  
pp. 162-165 ◽  
Author(s):  
Sergio Bertoglio ◽  
Carmine DiSomma ◽  
Paolo Meszaros ◽  
Marco Gipponi ◽  
Ferdinando Cafiero ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Femoral Vein ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous

scholarly journals Experimental surgical protocol for continuous femoral venous access in the rat

2019 ◽  
Vol 22 (3) ◽  
pp. 322-329
Author(s):  
Y. A. Goranova ◽  
I. M. Samnaliev ◽  
S. N. Nikolov ◽  
O. D. Zlatev ◽  
G. R. Kesov ◽  
...  
Keyword(s):  
Continuous Monitoring ◽  
Femoral Vein ◽  
Circulatory System ◽  
Monitoring And Evaluation ◽  
Venous Access ◽  
Systemic Circulation ◽  
Clinical Settings ◽  
Surgical Model ◽  
Experimental Pharmacology

Access to the circulatory system is essential for continuous monitoring and long-term experimental study. One of the commonest methods for venous access is femoral vein cannulation. The aim of the presented protocol was to elaborate a surgical model for cannulation of femoral vein in rat. Temporary cannulae such as butterfly needles can be used in short-term procedures, whereas long-term monitoring required surgical implantation of a biocompatible cannula. The protocol allows direct venous access, continuous monitoring and evaluation of the tested compounds in experimental pharmacology and toxicology – the tested compounds reach the systemic circulation immediately and the dose can be accurately titrated against response. The protocol can be applied as an alternative for venous access in experimental clinical settings.

scholarly journals INFLUENCE OF LONG-TERM CYTOTOXIC CHEMOTHERAPY ON THE CONDITION OF PERIPHERAL VENOUS CHANNEL

2017 ◽  
Vol 3 ◽  
pp. 49-55
Author(s):  
Tetiana Tkachuk
Keyword(s):  
Cancer Patients ◽  
Vascular Access ◽  
Venous Access ◽  
Term Treatment ◽  
Cytotoxic Chemotherapy ◽  
Cytotoxic Therapy ◽  
Qualitative And Quantitative ◽  
Long Term Treatment ◽  
Term Administration

The necessity of long-term venous access in cancer patients appears at frequent and long-term courses of cytotoxic therapy. Peripheral veins of forearms are most often used for these aims. The conditions of peripheral venous channel in 32 cancer patients, who underwent the long-term treatment with antitumor preparations were analyzed in the article on own investigatory material. The methods of dopplerography, morphological and immunohystochemical studies were used. The qualitative and quantitative dopplerographic changes in forearm veins in different terms after chemotherapy start were revealed in most patients. The conclusion was made about unsuitability of forearm peripheral veins for the long term administration of cytostatics and the necessity to create the alternative vascular access that would correspond to the criteria of safety, reliability and long-term exploitation.

Alternative exit sites for central venous access: Back tunneling to the scapular region and distal tunneling to the patellar region

2020 ◽  
pp. 112972982094017
Author(s):  
Matthew D Ostroff ◽  
Mauro Pittiruti
Keyword(s):  
Elderly Patients ◽  
Case Reports ◽  
Venous Access ◽  
Central Catheter ◽  
Exit Site ◽  
Catheter Dislodgement ◽  
Subcutaneous Tunneling ◽  
The Impact ◽  
Central Catheters ◽  
Scapular Region

Uncooperative elderly patients with cognitive disorder are often confused and/or agitated. Risk of involuntary venous access device dislodgment is high in these patients. This is equally likely with peripherally inserted central catheters and centrally inserted central catheters but less common with femorally inserted central catheters. Solutions to this problem include strict continuous patient observation, using sutures or subcutaneous anchored securement, wrapping the arm to “hide” the line, or using soft mittens to occupy the hands. However, some patients are able to disrupt the dressing, dislodge the catheter, and often pull the catheter out completely. In some cases, the patient may also overcome the resistance offered by the stitches or by the subcutaneous anchored securement device. In a recent paper on the impact of subcutaneously anchored securement in preventing dislodgment, the only demonstrated failures occurred in non-compliant elderly patients. Creation of an alternative exit site is an emerging trend in patients with cognitive impairment at high risk for catheter dislodgement. Subcutaneous tunneling from traditional insertion sites such as the jugular, axillary, or femoral veins allows placement of the exit site in a region inaccessible to the patient. The following two case reports demonstrate the technique for tunneling a femorally inserted central catheter downward to the patellar region and for tunneling a centrally inserted central catheter to the scapular region. Internal review board approval was not deemed necessary as subcutaneous tunneling is not a new technique. In our experience, such maneuvers can be successfully performed at the bedside.

Snare Technique for the Placement of a Peripherally Inserted Central Catheter in the Neonatal and Pediatric Patient

2010 ◽  
Vol 11 (2) ◽  
pp. 100-105 ◽  
Author(s):  
Wayne L. Monsky ◽  
Armando S. Garza ◽  
Shaun Loh ◽  
Daniel P. Link
Keyword(s):  
Pediatric Patients ◽  
Femoral Vein ◽  
Venous Access ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Leg Length ◽  
Vein Access ◽  
Procedural Complications

Purpose The placement of a peripherally inserted central catheter (PICC) for neonatal or pediatric patients may at times be technically challenging. We describe an alternate method of placing a PICC in neonatal and pediatric patients with difficult venous access. Methods An Amplatz gooseneck snare is advanced from the femoral vein to the basilic vein, as a target for puncture and guidewire positioning, allowing PIcc placement. Between 1999 and 2006, 44 PICCs were placed in the manner described. The medical records were reviewed allowing for up to 7 yrs of patient follow-up. Results Ninety-five percent of PICCs were successfully placed using the snare technique. Two placements were aborted and two procedural complications occurred. The review revealed no evidence of osteomyelitis, nerve injury, deep venous thrombosis or leg length discrepancy. Conclusion this technique offers an alternate method for PICC placement in neonatal and pediatric patients when conventional methods are unsuccessful. The technique avoids the need for intermediate to long-term jugular, subclavian or femoral vein access.

Tunneled femoral dialysis catheter: Practical pointers

2021 ◽  
pp. 112972982110396
Author(s):  
Yeshwanter Radhakrishnan ◽  
Jayaprakash Dasari ◽  
Evamaria Anvari ◽  
Tushar J Vachharajani
Keyword(s):  
Upper Extremity ◽  
Vascular Access ◽  
Dialysis Catheter ◽  
End Stage Kidney Disease ◽  
Central Venous ◽  
Femoral Catheter ◽  
Central Venous Stenosis ◽  
Current Review ◽  
End Stage

One of the most challenging aspects of providing end-stage kidney disease care is to achieve adequate long-term access to the bloodstream to support hemodialysis (HD) therapy. Although upper extremity arteriovenous fistula remains the vascular access of choice for patients on HD, complications such as central venous stenosis, access thrombosis, or exhaustion of suitable access sites in the upper extremity, ultimately result in pursuing vascular access creation in the lower extremity. The current review focuses on the indications, contraindications, and clinically relevant practical procedural tips to successfully place a tunneled femoral dialysis catheter. The review highlights some of the prevailing misconceptions regarding femoral catheter placement practices.

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