Vascular shunts and access Flashcards
type of vascular access that is mostly used in clinical practice
venous
types of venous access
peripheral
central
most common site for percutaneous peripheral catheterization
dorsal vein of the hand
why insertion to the lower extremeties is avoided in percutaneous peripheral catheterization
to avoid DVT
gauge number for bolus infusion
14
Gauge 14 is used for
bolus infusion
Gauge 18 is used for
volume transfusion
Gauge 16 is uaws for
rapid volume infusion
in neonates with fragile veins what gauge num is used
24
these are utilized before there were silicone and plastic sets
butterfly vein set
common sites for scalp vein cannulation for pedia
superficial temporal v
posterior auricular
supratrochlear
Emergency procedure in which the vein is exposed
surgically and then a cannula is inserted into the vein
under direct vision
peripheral venous cut down catheterization
why peripheral vein cut-down catheterization is not a favored procedure
relative morbidity
relative short patency
technical difficulty in dehydrated and hypotensive patients
primary choice for peripheral venous cut down catheterizatoin
great saphenous vein
advantage of central venous access
- long term use
- allows infusion of solutions that are too concentrated or irritating for the peripheral v
- allow monitoring of central venous pressure
important indications for central venous access
chronically ill px requiring repeated venous punctures for blood sampling and medication
- emergency access
- critical care monitoring pwp
- introduction of pacemakers
if you want to introduce pacemaker what access should you do
central venous access
absolute contraindications for central venous access
overlying skin and soft tissue infection
thrombophlebitis
why you should not insert a catheter through a thrombus vein
you will be removing the thrombus and cause embolus
what are the veins that are utilized in percutaneous polyethylene catheters
internal jugular
subclavian
femoral
preferred percutaneous catheterization for long term treatment needs
silicone catheters
borders of sedillot’s triangle
Sternal head of SCM medially
─ Clavicular head of SCM laterally
─ Superior border of the medial third of the clavicle
inferiorly
most utilized approach for percutaneous subclavian vein catheterization
infraclavicular approach
Junction of medial one-third and lateral twothirds
of clavicle
clavicular break
most common veins used in PICC line
saphenous or antecubital vein
indications for PICC
TPN
Blood sampling
administration of all medications
PICC line eliminate problems of
pneumothorax
air embolism
cardiac arrhythmia
disadvantage of PICC line
increased occlusion rate (small size)
Device of choice for patients who require long term or
even permanent access
implantable venous access device
advantages of implantable venous access device
less infection
less restriction of act
L altered body image
L dressing changes
method for accessing non collapsible venous plexuses thru the bone marrow cavity to systemic circulation
intraosseus access
what does the intraosseus method access
non-collapsible venous plexus thru the Bone marroy cavity
why intraosseus access was reintroduced in the 1980s
for rapid fluid infusion during resuscitation
previous guideline in intraosseus access
only children 6 or younger
sites for intraosseus access
areas that mature slowly Proximal Tibia below the growth plate Distal tibia above the medial malleolus Distal femur ASIS
Contraidnications of intraosseous access
- Fractures and crush injuries near the access site
- Fragile bone e.g. Osteogenesis imperfecta
- Previous attempts to access in the same bone
if venous accesss is not available w/in 1 min in a child with CP arrest what should you do
IO cannulation
IO needle placed in anterior tibia
indications for catheterization of Umb V
IV access in low birth weight infants (not more than
2 weeks)
Emergency IV access for resuscitation, medication,
and fluids
Blood sampling
Monitoring of central venous pressure
Exchange transfusion in the newborn
indications for catheterization of Umb A
Continuous blood-pressure monitoring Exchange transfusion in the newborn Arterial blood gas sampling Infusion of resuscitation drugs Infusion of maintenance solutions
risks in umb v/a catheterization
cardiac perforation
pericardial tamponade
portal HPN
if the catheter is incorrectly placed in the RA during umb v/a cat what could happen
cardiac perforation or pericardial tamponade
this assess blood gases and to continuously monitor blood
pressure (critically ill patients), invasive radiologic
interventional procedures
arterial vascular access
sites used in arterial vascular access
radial axillary
femoral
posterior tibial
dorsalis pedis
what arterydo most interventional cardiologist utilize for coronary angiogram?
radial artery
arteries that should be avoided in arterial vascular access
brachial
temporal
what would you perform first if you want to access arteries of the hand
allen’s test esp in px with peripheral arteriosum causing dse
why allen’s tetst is performed before radial artery cannulation
to determine wheter ulnar collateral circulation to the hand is adequate in case of radial art thrombosis
most commonly cannulated artery
radial
why ulnar artery is less commonly used
bcoz of its proximity to the ulnar nerve
this is used to make a passage or anastomosis btn 2 natural channels
vascular shunts
this is used for damage control surgery
vascular shunts
indications for temporaray intravascular shunting
Open extremities fractures with extensive soft tissue
injury and concurrent arterial injury (Gustillo IIIC)
Need for perfusion during complex vascular
reconstruction
Damage control for patients in extremities
Perfusion prior to limb replantation
Truncal vascular control
Complex repair of zone III neck injuries
Used to graft aneurysms, to bypass occlusion or served
as catheterizing device especially in trauma
temporary limb salvage shunt
this is used for blockade of the common carotid artery
brachial artery shunt
this shunt istemporarily installed to maintain perfusion
towards the brain while removing the thrombus
area (thickened intima)
brachial artery shunt
this is used in congenital anomalies esp TOF
modified Blalock taussig shunt
what arteries are connected in B-T shunt
pulmo and subclavian
Surgically created connection between a vein and an
artery
av fistula
av fistula is usually in
forearm
this allow access to the vascular system for adequate blood
flow during hemodialysis
av fistula
why av fistula is superior to graft and catheters
Increased patency
Decreased morbidity
Decreased cost
gold standard for hemodialysis access
av fistula
advantages of av fistula
good flow for dialysis
last longer
less likely to get infected or cause blood clots
disadvantages of av fistula
requires 2-3 mos to develop or mature
requires good inflow artery and good outflow vein
Vein mapping sometimes needed
acute complications of vascular access
Pneumothorax
Vascular damage (perforation, dissections)
Air embolism
Aberrant catheter placement
Damage to the thoracic duct
Cardiac complications (Cardiac irritation, cardiac
perforation)
Local tissue trauma or damage (bleeding into
surrounding tissues, nerve injury)
long term complications of vascular access
Infection and sepsis catheter induced septicemia Thrombotic complications (DVT, pulmonary embolus) Phlebitis of the cannulated vessel Superior vena cava syndrome Catheter dislodgement and migration
A 5 day old infant has to undergo arterial blood
gas monitoring, which is the best access site to
be used?
umbilical artery
Patient ICU needs total parenteral nutrition.
Which is the best catheter to be used for this?
peripherally inserted central catheter
Which CVC site is the easiest access in a trauma
code situation
femoral
Considered in hemodialysis patients who are older
and/or has small veins and are not considered
good candidates for AV fistula.
av graft
Beneficial for cancer patients who requires
repeated access for chemotherapy
implantable venous access device
What is the ideal time to use a winged infusion set?
for IV push drugs
