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

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.

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External jugular venous catheterization with a Groshong catheter for central venous access

Journal of Surgical Oncology ◽

10.1002/jso.21064 ◽

2008 ◽

Vol 98 (1) ◽

pp. 67-69 ◽

Cited By ~ 7

Author(s):

Mitsuru Ishizuka ◽

Hitoshi Nagata ◽

Kazutoshi Takagi ◽

Keiichi Kubota

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Venous Catheterization

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Central Venous Access Device Insertion by Qualified Vascular Access Specialists or Other Applicable Healthcare Clinicians

Journal of the Association for Vascular Access ◽

10.2309/j.java.2020.01.001 ◽

2020 ◽

Vol 25 (1) ◽

pp. 52-55

Author(s):

Timothy R. Spencer ◽

Amy Bardin-Spencer

Keyword(s):

Vascular Access ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Central Venous Access Device ◽

Access Device ◽

Venous Access Device

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Advanced vascular access

Paediatric Anaesthesia ◽

10.1093/med/9780198755791.003.0010 ◽

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.

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Rapid Central Vein Assessment (RaCeVA): A systematic, standardized approach for ultrasound assessment before central venous catheterization

The Journal of Vascular Access ◽

10.1177/1129729818804718 ◽

2018 ◽

Vol 20 (3) ◽

pp. 239-249 ◽

Cited By ~ 24

Author(s):

Timothy R Spencer ◽

Mauro Pittiruti

Keyword(s):

Vascular Access ◽

Central Venous Catheterization ◽

Central Vein ◽

Arterial Cannulation ◽

Central Venous ◽

Anatomical Structures ◽

Venous Catheterization ◽

Ultrasound Technology ◽

Ultrasound Assessment ◽

Vascular Structures

Ultrasound technology has revolutionized the practice of safer vascular access, for both venous and arterial cannulation. The ability to visualize underlying structures of the chest, neck, and upper/lower extremities provides for greater success, speed, and safety with all vascular access procedures. Ultrasound not only yields superior procedural advantages but also provides a platform to perform a thorough assessment of the vascular structures to evaluate vessel health, viability, size, and patency, including the location of other important and best avoided anatomical structures—prior to performing any procedures. Such assessment is best performed using a systematic and standardized approach, as the Rapid Central Vein Assessment, described in this study.

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A retrospective analysis of the clinical effectiveness of subcutaneously tunneled femoral vein cannulations at the bedside: A low risk central venous access approach in the neonatal intensive care unit

The Journal of Vascular Access ◽

10.1177/1129729820969291 ◽

2020 ◽

pp. 112972982096929

Author(s):

Matthew Ostroff ◽

Adel Zauk ◽

Sara Chowdhury ◽

Nancy Moureau ◽

Carly Mobley

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Retrospective Analysis ◽

Neonatal Intensive Care ◽

Femoral Vein ◽

Central Venous Access ◽

Venous Access ◽

Right Atrial ◽

Central Venous

Objective: The purpose of this retrospective analysis was to evaluate the clinical efficacy and safety of ultrasound (US)-guided, subcutaneously tunneled, femoral inserted central catheters (ST-FICCs) in the neonatal intensive care unit (NICU). Methods: Following clinical success with ST-FICCs in adults, we expanded this practice to the neonatal population. In an 18-month retrospective cohort analysis (2018–2020) of 82 neonates, we evaluated the clinical outcome for procedural success, completion of therapy, and incidence of early and late complications for insertion of US-guided ST-FICCs in the NICU. Results: Placement of ST-FICCs were successful in 100% of neonates ( n = 82/82) with 94% to the right ( n = 77/82) and 6% to the left common femoral veins ( n = 5/82). Gestational age ranged 23-39 weeks with median age of 29 weeks. Birthweight ranged from 450 g to >2000 g. Weight at insertion ranged 570 to 3345 g and day of life 1 to 137, with median at day 5. Ultrasound guided femoral vein puncture was recorded on 74 patients, first attempt 63/74 (85%), second attempt 8/74 (11%) and third attempt 3/74 (4%). Catheter french used: 1.9Fr ( n = 80/82), 2.6Fr ( n = 1/82), and 3-Fr ( n = 1/82). Catheter lengths were 8 to 20 cm, average 12cm. Catheter termination confirmed with posterior/anterior and lateral abdominal radiographs with inferior vena cava (IVC) ( n = 33/82), IVC/right atrial junction ( n = 31/82), or right atrium ( n = 18/82). Atrial placements were retracted; no cases of malposition to the lumbar/renal/hepatic veins ( n = 0/82). 1528 catheter days ranging 5 to 72 days (average 18). No insertion-related or post-insertion complications. All patients completed prescribed therapy with one catheter. Conclusion: Bedside placement of an ST-FICC is a safe route for central venous access in the NICU, preserving upper extremity vasculature, eliminates risks associated with sedation, fluoroscopy, tunneled and non-tunneled supra-diaphragmatic central venous insertion.

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A dedicated consultant-led vascular access team significantly reduces out-of-hours and emergency permanent central venous access insertions

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2009.10.089 ◽

2010 ◽

Vol 45 (2) ◽

pp. 419-421 ◽

Cited By ~ 6

Author(s):

John M. Wells ◽

Wajid B. Jawaid ◽

Peter Bromley ◽

James Bennett ◽

G. Surren Arul

Keyword(s):

Vascular Access ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Out Of Hours

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A modified approach for ultrasound-guided axillary venipuncture in the infraclavicular area: A retrospective observational study

The Journal of Vascular Access ◽

10.1177/1129729819838135 ◽

2019 ◽

Vol 20 (6) ◽

pp. 630-635

Author(s):

Minmin Yao ◽

Wanxia Xiong ◽

Liying Xu ◽

Feng Ge

Keyword(s):

Observational Study ◽

Success Rate ◽

Central Venous Access ◽

Demographic Data ◽

Venous Access ◽

Axillary Vein ◽

Ultrasound Guided ◽

Central Venous ◽

Venous Catheterization ◽

Out Of Plane

Background: Catheterization of the axillary vein in the infraclavicular area has important advantages in patients with long-term, indwelling central venous catheters. The two most commonly used ultrasound-guided approaches for catheterization of the axillary vein include the long-axis/in-plane approach and the short-axis/out-of-plane approach, but there are certain drawbacks to both approaches. We have modified a new approach for axillary vein catheterization: the oblique-axis/in-plane approach. Methods: This observational study retrospectively collected data from patients who underwent ultrasound-guided placement of an axillary vein infusion port in the infraclavicular area at the Central Venous Access Clinics of Zhongshan Hospital at Fudan University between March 2014 and May 2017. The patients’ demographic data, success rate of catheterization, venous catheterization site, and immediate complications associated with catheterization were recorded. Results: Between March 2014 and May 2017, a total of 858 patients underwent placement of an axillary vein infusion port in the infraclavicular area at our center. The ultrasound-guided oblique-axis/in-plane approach was used for all patients, and the venipuncture success rate was 100%. Two cases of accidental arterial puncture and one case of local hematoma formation were reported, and no other complications, such as pneumothorax or nerve damage, were reported. Conclusion: The ultrasound-guided oblique-axis/in-plane approach is a safe and reliable alternative to the routine ultrasound-guided approach for axillary venous catheterization.

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