DOCSLIB.ORG

Chapter 38 CENTRAL VENOUS ACCESS

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Chapter 38 CENTRAL VENOUS ACCESS 0162t_c038_ 5/20/03 1:32 PM Page 314 mac111 mac111: 272_VE: Chapter 38 CENTRAL VENOUS ACCESS Robert Feldman INTRODUCTION icular heads of the sternocleidomastoid muscle. The in- ternal jugular vein increases in diameter as it descends. Percutaneous cannulation of the central veins is an es- It is joined by tributary veins in the upper neck, making sential technique for both long-term and emergent med- it easier to cannulate below the level of the cricoid ical care. Access to the major veins of the torso allows cartilage. rapid high-volume fluid resuscitation, administration of The internal jugular vein is collapsible (Figure 38-3). It concentrated ionic and nutritional solutions, and hemo- has a very small diameter in low-flow states, as during dynamic measurements. cardiopulmonary resuscitation (CPR) and when the pa- tient is upright. The vein is easily compressible and will collapse with gentle external pressure from a palpating ANATOMY AND PATHOPHYSIOLOGY finger or a large-diameter needle indenting the skin (Fig- ure 38-3B). Fortunately, the vein is also very distensible. The tip of the central venous catheter must lie in the Placing the patient in the Trendelenburg position or hav- superior or inferior vena cava and never in the right ing the patient perform the Valsalva maneuver will dis- atrium. The thin wall of the right atrium may easily be tend the vein and help to locate the vessel (Figure 38-3C). perforated by the catheter tip, resulting in hemorrhage The common carotid artery travels alongside the in- and cardiac tamponade. The central venous anatomy is ternal jugular vein and is an important anatomic land- shown in Figure 38-1. The superior vena cava is accessed mark for locating the internal jugular vein. The carotid through the internal jugular veins, the subclavian veins, artery runs deep and slightly anterior to the internal and less commonly via the external jugular veins. The jugular vein. The left internal jugular vein usually over- inferior vena cava is accessed through the femoral veins. laps the carotid artery in the lower neck (Figure 38-3A). These access routes are discussed in greater detail in the The right internal jugular vein and the right carotid ar- corresponding sections below. The advantages and dis- tery are usually separated slightly. advantages of each route for central venous access are The right internal jugular vein is generally preferred summarized in Table 38-1. to the left internal jugular vein as the site of central venous cannulation. The right internal jugular vein pro- INTERNAL JUGULAR VEIN vides a nearly direct route to the superior vena cava. The The internal jugular vein is not directly visible from dome of the right lung is somewhat lower than that of the surface of the skin. A thorough knowledge of its the left lung and thus decreases the chance of a pneu- anatomic relationships is essential for successful cannu- mothorax. The thoracic duct is relatively large and lies lation. The internal jugular vein exits the skull through high in the left chest. These favor the right internal jugu- the jugular foramen, just anteromedial to the mastoid lar approach to central venous cannulation to minimize process.1 It joins the subclavian vein deep and just lat- complications.1,2 eral to the head of the clavicle1 (Figure 38-2). The surface There are three main approaches to the internal jugu- projection of the internal jugular vein runs from the ear- lar vein as defined by their relationship to the sternoclei- lobe to the medial clavicle, between the sternal and clav- domastoid muscle. These are the anterior, central, and 314 0162t_c038_ 5/20/03 1:32 PM Page 315 mac111 mac111: 272_VE: CHAPTER 38 / CENTRAL VENOUS ACCESS 315 Brachiocephalic veins Internal and external jugular veins Left subclavian vein Superior vena cava Right atrium Inferior vena cava Common Aorta iliac vein Anterior superior iliac spine Inguinal ligament Femoral vein Pubic symphysis FIGURE 38-1 The anatomy of the central venous system. posterior approaches (Figures 38-4, 38-5, and 38-6). The ternal jugular vein and form the brachiocephalic trunk, central approach is most commonly used. These three which empties into the superior vena cava. approaches are summarized in Table 38-2. The subclavian veins are 1 to 2 cm in diameter in an adult. Fibrous connective tissue joins the subclavian SUBCLAVIAN VEIN vein to the clavicle and first rib, preventing collapse of The subclavian vein begins as the continuation of the the vessel even in the event of a cardiac arrest. Anatomi- axillary vein at the lateral edge of the first rib1,3–5 (Figure cally associated structures include the thoracic duct, 38-7). The subclavian vein courses anterior to the ante- which joins the left subclavian vein at its junction with rior scalene muscle, which separates it from the subcla- the left internal jugular vein. The right subclavian vein is vian artery. The subclavian vein descends to join the in- preferred to the left for central venous access for this TABLE 38-1. CHARACTERISTICS OF THE VARIOUS ROUTES OF CENTRAL VENOUS CANNULATION Internal jugular External jugular vein vein Subclavian vein Femoral vein Risk of infection Low Low Low High Patient mobility Fair Poor Good Bedridden Trendelenburg required? Yes Yes Yes No, best for CHF or dyspnea Need to stop CPR? Probably Probably Yes No, may continue CPR Suitable for long-term use? Yes, but not if ambulatory No Yes—best choice No, remove within 2–3 days Risk of venous thrombosis Low Low Low High 0162t_c038_ 5/20/03 1:32 PM Page 316 mac111 mac111: 272_VE: 316 SECTION THREE / VASCULAR PROCEDURES Left common Left subclavian carotid artery vein and artery Facial vein Aortic arch Superior vena cava Right brachiocephalic artery and vein Apex of lung Mastoid Internal process jugular vein FIGURE 38-2 Anatomy and surface relationships of the internal jugular vein. reason. The domes of the pleura lie posterior and infe- pulse. During CPR chest compressions, attempt punc- rior to the subclavian veins and medial to the anterior ture directly over the pulsations if an initial attempt at scalene muscles. The subclavian arteries lie immediately femoral vein cannulation medial to the pulse fails. posterior to the veins. The puncture site to enter the femoral vein must be at Subcutaneous fatty tissue, chest morphology, the least 1 to 2 cm inferior to the inguinal ligament, depend- close proximity of the pleura, and the close proximity of ing on the patient’s size. The femoral vein becomes the the subclavian artery make the subclavian vein the least external iliac vein superior to the inguinal ligament favored site for central venous access in children. This is (Figure 38-8). Blood can flow freely into the retroperi- especially true in infants. An experienced practitioner toneal space,forming a potentially large and externally should perform the procedure if this route must be used invisible hematoma if the posterior wall of the femoral in a neonate, infant, or small child. vein is punctured by a through-and-through needle track above the inguinal ligament. It is imperative to FEMORAL VEIN puncture the femoral vein inferior to the inguinal The puncture site for femoral vein cannulation lies ligament! medial to the femoral artery and inferior to the inguinal ligament1,2,6 (Figure 38-8). The femoral vein lies within the femoral sheath and just medial to the femoral artery INDICATIONS in the groin. This relationship can be remembered by the mnemonic “toward the NAVEL.” This describes, from The internal jugular route is acceptable for central ve- lateral to medial, the contents of the femoral sheath nous access in most cases. It allows ready access to the (femoral Nerve, femoral Artery, femoral Vein, Empty superior vena cava for long-term central venous access, space, and Lymphatics). The femoral artery lies at the caustic infusions, and monitoring of central venous midpoint of a line connecting the symphysis pubis and pressure. Pulmonary artery catheters and transvenous the anterior superior iliac spine.1,6 The femoral vein lies pacing wires can be introduced through the right inter- approximately 1 cm medial to the femoral artery pulse in nal jugular vein. The internal jugular vein is accessible an adult.3,7 It lies approximately 5 mm medial to the without terminating CPR efforts, although chest com- femoral artery in infants and young children.3,7 The pressions and the lack of carotid pulsations make access- femoral venous pulse may be felt instead of the arterial ing it difficult. The risk of a pneumothorax is probably 0162t_c038_ 5/20/03 1:32 PM Page 317 mac111 mac111: 272_VE: CHAPTER 38 / CENTRAL VENOUS ACCESS 317 A C B FIGURE 38-3 Ultrasonic cross sections of the left internal jugular vein (IJV) and carotid artery (CA). A. The patient is supine. B. With gentle external pressure applied, the low- pressure internal jugular vein collapses easily while the carotid is still patent. C. The Valsalva maneuver or place- ment of the patient in the Trendelenburg position dilates the internal jugular vein. less with the internal jugular vein cannulation as position. Femoral venous access is relatively easy during opposed to the subclavian vein route, although patient CPR and often does not require the cessation of chest mobility is less and discomfort is greater. In a coagulo- compressions. The femoral vein is easily compressible. pathic patient, the internal jugular vein puncture site is This makes it preferable to the subclavian vein in coagu- compressible, but hematoma formation may lead to lopathic patients or those undergoing thrombolysis, compromise of the airway. although peripheral access would be preferred in these The subclavian vein is the preferred route for longer- cases.8 There is no risk of injury to the airway, pleura, or term central venous access.
Load more

Recommended publications
  • Prep for Practical II
    Images for Practical II BSC 2086L "Endocrine" A A B C A. Hypothalamus B. Pineal Gland (Body) C. Pituitary Gland "Endocrine" 1.Thyroid 2.Adrenal Gland 3.Pancreas "The Pancreas" "The Adrenal Glands" "The Ovary" "The Testes" Erythrocyte Neutrophil Eosinophil Basophil Lymphocyte Monocyte Platelet Figure 29-3 Photomicrograph of a human blood smear stained with Wright’s stain (765). Eosinophil Lymphocyte Monocyte Platelets Neutrophils Erythrocytes "Blood Typing" "Heart Coronal" 1.Right Atrium 3 4 2.Superior Vena Cava 5 2 3.Aortic Arch 6 4.Pulmonary Trunk 1 5.Left Atrium 12 9 6.Bicuspid Valve 10 7.Interventricular Septum 11 8.Apex of The Heart 9. Chordae tendineae 10.Papillary Muscle 7 11.Tricuspid Valve 12. Fossa Ovalis "Heart Coronal Section" Coronal Section of the Heart to show valves 1. Bicuspid 2. Pulmonary Semilunar 3. Tricuspid 4. Aortic Semilunar 5. Left Ventricle 6. Right Ventricle "Heart Coronal" 1.Pulmonary trunk 2.Right Atrium 3.Tricuspid Valve 4.Pulmonary Semilunar Valve 5.Myocardium 6.Interventricular Septum 7.Trabeculae Carneae 8.Papillary Muscle 9.Chordae Tendineae 10.Bicuspid Valve "Heart Anterior" 1. Brachiocephalic Artery 2. Left Common Carotid Artery 3. Ligamentum Arteriosum 4. Left Coronary Artery 5. Circumflex Artery 6. Great Cardiac Vein 7. Myocardium 8. Apex of The Heart 9. Pericardium (Visceral) 10. Right Coronary Artery 11. Auricle of Right Atrium 12. Pulmonary Trunk 13. Superior Vena Cava 14. Aortic Arch 15. Brachiocephalic vein "Heart Posterolateral" 1. Left Brachiocephalic vein 2. Right Brachiocephalic vein 3. Brachiocephalic Artery 4. Left Common Carotid Artery 5. Left Subclavian Artery 6. Aortic Arch 7.
    [Show full text]
  • Vessels and Circulation
    CARDIOVASCULAR SYSTEM OUTLINE 23.1 Anatomy of Blood Vessels 684 23.1a Blood Vessel Tunics 684 23.1b Arteries 685 23.1c Capillaries 688 23 23.1d Veins 689 23.2 Blood Pressure 691 23.3 Systemic Circulation 692 Vessels and 23.3a General Arterial Flow Out of the Heart 693 23.3b General Venous Return to the Heart 693 23.3c Blood Flow Through the Head and Neck 693 23.3d Blood Flow Through the Thoracic and Abdominal Walls 697 23.3e Blood Flow Through the Thoracic Organs 700 Circulation 23.3f Blood Flow Through the Gastrointestinal Tract 701 23.3g Blood Flow Through the Posterior Abdominal Organs, Pelvis, and Perineum 705 23.3h Blood Flow Through the Upper Limb 705 23.3i Blood Flow Through the Lower Limb 709 23.4 Pulmonary Circulation 712 23.5 Review of Heart, Systemic, and Pulmonary Circulation 714 23.6 Aging and the Cardiovascular System 715 23.7 Blood Vessel Development 716 23.7a Artery Development 716 23.7b Vein Development 717 23.7c Comparison of Fetal and Postnatal Circulation 718 MODULE 9: CARDIOVASCULAR SYSTEM mck78097_ch23_683-723.indd 683 2/14/11 4:31 PM 684 Chapter Twenty-Three Vessels and Circulation lood vessels are analogous to highways—they are an efficient larger as they merge and come closer to the heart. The site where B mode of transport for oxygen, carbon dioxide, nutrients, hor- two or more arteries (or two or more veins) converge to supply the mones, and waste products to and from body tissues. The heart is same body region is called an anastomosis (ă-nas ′tō -mō′ sis; pl., the mechanical pump that propels the blood through the vessels.
    [Show full text]
  • Vein Preservation and Alternative Venous Access Exploring the Options for Patients with Chronic Kidney Disease
    AV/DIALYSIS ACCESS UPDATE Vein Preservation and Alternative Venous Access Exploring the options for patients with chronic kidney disease. BY THEODORE F. SAAD, MD ince the inception of chronic hemodialysis and the in most cases, although some patients with adequate collat- introduction of the Brescia-Cimino arteriovenous fis- eral venous outflow may develop a functional arteriovenous tula,1 there has been a strong culture favoring vein fistula despite ipsilateral central vein stenosis or occlusion. preservation in the nephrology and hemodialysis Nondominant versus dominant arm: The nondominant Scommunity. During the past 3 decades, there has been con- arm is generally preferred for construction of arteriovenous tinuous growth in the patient population with chronic kid- access. However, depending upon individual patient anato- ney disease (CKD), as well as advances in many medical my and circumstance, the dominant arm is frequently used therapies requiring venous access devices. Many alternatives for hemodialysis access. Therefore, all the same considera- for venous access now exist, including conventional periph- tions apply. eral intravenous catheters, peripherally inserted central catheters (PICCs), nontunneled central venous catheters, DAMAGE CONTROL tunneled central venous catheters (with or without a subcu- Venous access devices damage veins. This is true for any taneous cuff), and subcutaneously implanted ports utilizing intravenous device that is introduced into any peripheral or either central or peripheral veins. As a result, there is consid- central vein. This damage may involve direct trauma to the erable pressure on the limited venous “real estate” available actual puncture site of the vessel, or there may be damage for placement of these devices and creation of arteriove- induced by contact of the device and the vein wall at points nous access.
    [Show full text]
  • Internal Jugular Venous Ectasia in an Adult Female Surgery Section
    DOI: 10.7860/JCDR/2018/37443.12129 Case Report Internal Jugular Venous Ectasia in an Adult Female Surgery Section BHARATHGURU NEDUMARAN1, ARUNKUMAR KRISHNASAMY2 ABSTRACT Jugular phlebectasia refers to a saccular or fusiform dilatation of the neck veins. Phlebectasia involving the jugular veins is an entity which is diagnosed more commonly in children presenting with neck swellings, after ruling out other common causes. It is also called a venous aneurysm, venous ectasia or essential venous dilatation. This can affect all neck veins-internal jugular, external jugular, anterior jugular and superficial communicating veins in order of decreasing frequency. Although, various theories have been proposed, there is no general consensus among various authors regarding the cause for its occurrence. It is predominantly congenital in origin. The diagnosis is based on clinical presentation aided by non-invasive imaging modalities. The venous ectasia is being increasingly recognised due to advances in radiographic imaging. Management is mainly conservative and surgery is required only when complications arise. Here, authors present a case of venous ectasia in an adult female who presented with complaints of the presence of a vague swelling in her neck. Keywords: Cervical swelling, Internal jugular vein, Phlebectasia, Venous aneurysm CASE REPORT A 39-year-old lady presented to Department of Cardiothoracic Surgery with complaints of pain and swelling over the right side of the neck for the past six months. She attributed the pain to an injury sustained six months back. She gave a history of palpitations and occasional breathing difficulty. She had no difficulty in swallowing and no hoarseness of voice. On general examination, she was healthy with no other significant abnormalities.
    [Show full text]
  • Prehosp Fluid
    PRACTICE MANAGEMENT GUIDELINES FOR PREHOSPITAL FLUID RESUSCITATION IN THE INJURED PATIENT EAST Practice Parameter Workgroup for Pre-hospital Fluid Resuscitation Bryan A. Cotton, MD, 1 Bryan R. Collier, DO, 1 Suneel Khetarpal, MD, 2 Michelle Holevar, MD, 3 Brian Tucker, DO, 4 Stan Kurek, DO, 4 Nathan T. Mowery, MD,1 Kamalesh Shah, MD, 5 William Bromberg, MD, 6 Oliver L. Gunter, MD, 7 William P. Riordan, Jr, MD, 1 1 Vanderbilt University Medical Center, Nashville, TN 2 Tampa General Hospital, Tampa, FL 3 Mount Sinai Hospital, Chicago, IL 4 University of Tennessee-Knoxville Medical Center, Knoxville, TN 5 Lehigh Valley Hospital and Health Network, Allentown, PA 6 Memorial Health University Medical Center, Savannah, GA 7 Washington University/Barnes Jewish Medical Center, St. Louis, MO Address for Correspondence and Reprints: Bryan A Cotton, MD VUMC-Trauma 1211 21st Ave South, 404 Medical Arts Building Nashville, TN 37212 Phone: (615)-936-0189 Fax: (615)-936-0185 E-mail: [email protected] ©2008 Eastern Association for the Surgery of Trauma 2 I. STATEMENT OF THE PROBLEM Over the past several decades, the scope of practice for emergency medical personnel has rapidly expanded. 1 Along with this, a dramatic increase in the number of pre-hospital procedures (especially intubation and central venous access) has been noted.2, 3 However, this dramatic change in the pre-hospital approach to the injured patient has occurred in the absence of data to support its adoption. Investigators from Los Angeles have noted no difference in survival when injured patients are transported by private vehicle or emergency medical services (EMS) transport.
    [Show full text]
  • Right Heart Catheter (Internal Jugular Vein Approach) Designation:
    11 .au (Affix identification label here) URN: Family name: Right Heart Catheter (Internal Given name(s): Jugular Vein Approach) Address: Date of birth: Sex: M F I Facility: A. Interpreter / cultural needs • Abnormal heart rhythm that continues for a long time. This may need an electric shock to correct. An Interpreter Service is required? Yes No • The carotid artery (in the neck) is accidentally If Yes, is a qualified Interpreter present? Yes No punctured. This may require surgery to repair. © The State of Queensland (Queensland Health), 20 A Cultural Support Person is required? Yes No Rare risks and complications (less than 1%) If Yes, is a Cultural Support Person present? Yes No include: • Infection. This will need antibiotics. B. Condition and treatment • Allergic reaction to the local anaesthetic. This The doctor has explained that you have the following may require medication to treat. Permission to reproduce should be sought from [email protected] condition: (Doctor to document in patient’s own words) • Blood clot in the neck vein. This may need medication to treat. .................................................................................................................................................................... • Embolism. A blood clot may form and break off .................................................................................................................................................................... from the catheter. This is treated with blood This condition requires the following procedure. thinning medication. • (Doctor to document - include site and/or side where Air in the lung cavity. A chest tube may need to relevant to the procedure) be put in to the chest to drain the air. • Damage to the vein in the neck causing bleeding. .................................................................................................................................................................... This may need surgery to repair. The following will be performed: • Air embolism. Oxygen may be given.
    [Show full text]
  • Anatomy and Physiology in Relation to Compression of the Upper Limb and Thorax
    Clinical REVIEW anatomy and physiology in relation to compression of the upper limb and thorax Colin Carati, Bren Gannon, Neil Piller An understanding of arterial, venous and lymphatic flow in the upper body in normal limbs and those at risk of, or with lymphoedema will greatly improve patient outcomes. However, there is much we do not know in this area, including the effects of compression upon lymphatic flow and drainage. Imaging and measuring capabilities are improving in this respect, but are often expensive and time-consuming. This, coupled with the unknown effects of individual, diurnal and seasonal variances on compression efficacy, means that future research should focus upon ways to monitor the pressure delivered by a garment, and its effects upon the fluids we are trying to control. More is known about the possible This paper will describe the vascular Key words effects of compression on the anatomy of the upper limb and axilla, pathophysiology of lymphoedema when and will outline current understanding of Anatomy used on the lower limbs (Partsch and normal and abnormal lymph drainage. It Physiology Junger, 2006). While some of these will also explain the mechanism of action Lymphatics principles can be applied to guide the use of compression garments and will detail Compression of compression on the upper body, it is the effects of compression on fluid important that the practitioner is movement. knowledgeable about the anatomy and physiology of the upper limb, axilla and Vascular drainage of the upper limb thorax, and of the anatomical and vascular It is helpful to have an understanding of Little evidence exists to support the differences that exist between the upper the vascular drainage of the upper limb, use of compression garments in the and lower limb, so that the effects of these since the lymphatic drainage follows a treatment of lymphoedema, particularly differences can be considered when using similar course (Figure 1).
    [Show full text]
  • 2017 the Science and Fundamentals of Intraosseous Vascular Access Including Frequently Asked Questions
    EZ-IO Intraosseous Vascular from TELEFLEX Access System Arrow® EZ-IO® Intraosseous Vascular Access System 2017 The Science and Fundamentals of Intraosseous Vascular Access including Frequently Asked Questions Teleflex Global Research and Scientific Services, a Division of Clinical and Medical Affairs 1 2 2017 Third Edition Introduction . 8 Indications/Contraindications and General Intraosseous (IO) Use . 10 When can the Arrow® EZ-IO® Intraosseous Vascular Access System from Teleflex be used? . 10 In what type of clinical scenarios is IO vascular access used? . 10 Can the Arrow® EZ-IO® Intraosseous Vascular Access System Device be used in the sternum? . 11 What is off-label use of the Arrow® EZ-IO® Device? . 11 Can nurses and medics perform IO device insertions? . 11 Do professional organizations support IO vascular access for clinical applications? . 11 Is special training or certification required prior to using the EZ-IO® Device? . 12 Anatomy and Physiology of the IO Space . .12 How does the IO vascular access route work? . 12 Which insertion site works best? . 12 Anatomy . 13 Physiology . 13 Intramedullary pressure . 14 During CPR: guidelines . 14 Preclinical studies . 15 Clinical studies . 17 Technique/Training . .21 How should the skin be prepared for IO insertion? . 21 Is a local anesthetic necessary for EZ-IO® Device insertion in an alert patient? . 21 How is appropriate EZ-IO® Needle Set length determined? Can the “pediatric” needle sets be used in adults, or “adult” needle sets in pediatric patients? . 21 How deep should the EZ-IO® Needle Set be inserted into the bone? . 22 3 What if the driver seems to be losing power and slows down? .
    [Show full text]
  • The Hemodynamic Effect of Unilateral Carotid Ligation on the Cerebral Circulation of Man*
    THE HEMODYNAMIC EFFECT OF UNILATERAL CAROTID LIGATION ON THE CEREBRAL CIRCULATION OF MAN* HENRY A. SHENKIN, M.D., FERNANDO CABIESES, M.D., GORDON VAN DEN NOORDT, M.D., PETER SAYERS, M.D., AND REUBEN COPPERMAN, M.A. Neurosurgical Service, Graduate Hospital, and Harrison Department of Surgical Re- search, Schools of Medicine, University of Pennsylvania, Philadelphia (Received for publication July ~5, 1950) HE increasing incidence of surgical attack upon vascular anomalies of the brain has renewed interest in the physiological responses of the T cerebral circulation to occlusion of a carotid vessel. This question has been studied in lower animals by Rein, 5 the Schneiders, 6 Bouckaert and Heymans 1 and by the late Cobb Pilcher. 4 However, because of the lack of an adequate technique for measuring the cerebral blood flow and because of the fact that lower animals have a rich intercommunication between the intracerebral and extracerebral circulations, very few data pertinent to human physiology have been accumulated. There are two important points to be established concerning carotid ligation: firstly, its therapeutic effect, that is the degree of fall of pressure in the vessels distal to the ligation, and secondly, its safety, determined by its effect on the cerebral blood flow. Sweet and Bennett, 8 by careful measurement of pressure changes distal to ligation, have provided informa- tion on the former point. It is the latter problem that is the subject of this paper. METHODS The subjects of this study were 4 patients with intracranial arterial aneurysms subjected to unilateral common carotid artery ligation. They ranged in age from 15 to 53 years (Table 1).
    [Show full text]
  • An Overview of Central Venous Access Devices
    NursingNursing ManagementManagement ofof VenousVenous AccessAccess Devices:Devices: AnAn OverviewOverview ofof CentralCentral VenousVenous AccessAccess DevicesDevices Mimi Bartholomay, RN, MSN, AOCN Denise Dreher, RN, CRNI, VA-BC Theresa Evans, RN, MSN Susan Finn, RN, MSN, AOCNS Debra Guthrie, RN, CRNI Hannah Lyons, RN, MSN, AOCN Janet Mulligan, RN, MS, VA-BC Carol Tyksienski, M.S.,R.N.,N.P CentralCentral VenousVenous AccessAccess DevicesDevices ((CVADsCVADs)) PeripherallyPeripherally InsertedInserted CentralCentral CathetersCatheters ((PICCsPICCs)) NonNon--tunneledtunneled catheters:catheters: SubclavianSubclavian // JugularJugular // FemoralFemoral LinesLines TunneledTunneled catheters:catheters: HickmansHickmans // BroviacsBroviacs // GroshongsGroshongs // SmallSmall BoreBore ImplantedImplanted ports:ports: PortPort--aa--cathscaths // PassportsPassports CentralCentral VADsVADs ““...first...first lineline ofof defense,defense, notnot aa devicedevice ofof lastlast resortresort”” Candidates:Candidates: Long-term therapies ( > one week) TPN Chemotherapy / vesicants Drugs with pH <5 or >9 Long term antibiotic therapy Hypertonic solutions (osmolality >600mOsm/L) ex.- 3% saline Limited venous access VerificationVerification ofof CentralCentral LinesLines ConfirmationConfirmation ofof typetype ofof centralcentral lineline andand lineline placementplacement MUSTMUST bebe verifiedverified beforebefore useuse UntilUntil verificationverification isis complete,complete, thethe cathetercatheter mustmust bebe markedmarked withwith aa
    [Show full text]
  • What Is Venous Thoracic Outlet Syndrome?
    Venous Thoracic Outlet Syndrome An In-Depth Guide for Patients and Healthcare Providers By: Holly Grunebach, MSPH, PA-C, Ying-Wei Lum, MD, MPH Division of Vascular Surgery and Endovascular Therapy Johns Hopkins Hospital 600 N Wolfe St, Halsted 668 Baltimore, MD 21287 1. What is venous thoracic outlet syndrome? Venous thoracic outlet syndrome is a condition that occurs when the subclavian vein is compressed by the first rib and the subclavius/anterior scalene muscle resulting in a blood clot. The anterior scalene is a muscle located in the neck that attaches to the first rib in the area known as the thoracic outlet. Typically, the structures that control the function of the arm including the subclavian artery, subclavian vein and the nerves of the brachial plexus are able to pass through this area without incident. (Figure) In the case of venous thoracic outlet syndrome the veins are compressed which results in a blood clot. 2. What causes venous thoracic outlet syndrome? Venous thoracic outlet syndrome occurs over time as the subclavian vein is compressed by the subclavius/anterior scalene muscle and first rib with arm use. With the arms in an extended or overhead position, the space around the structures within the thoracic outlet space narrows. In thoracic outlet syndrome this space becomes so narrow that compression of the subclavian vein occurs triggering blood clot formation. 3. What are signs and symptoms of venous thoracic outlet syndrome? Persistent swelling with pain and color change in the arm is typical in patients with venous thoracic outlet syndrome. These symptoms are usually persistent and unable to be relieved with other conservative treatments.
    [Show full text]
  • The Cardiovascular System
    11 The Cardiovascular System WHAT The cardiovascular system delivers oxygen and HOW nutrients to the body tissues The heart pumps and carries away wastes blood throughout the body such as carbon dioxide in blood vessels. Blood flow via blood. requires both the pumping action of the heart and changes in blood pressure. WHY If the cardiovascular system cannot perform its functions, wastes build up in tissues. INSTRUCTORS Body organs fail to function properly, New Building Vocabulary and then, once oxygen becomes Coaching Activities for this depleted, they will die. chapter are assignable in hen most people hear the term cardio- only with the interstitial fluid in their immediate Wvascular system, they immediately think vicinity. Thus, some means of changing and of the heart. We have all felt our own “refreshing” these fluids is necessary to renew the heart “pound” from time to time when we are ner- nutrients and prevent pollution caused by vous. The crucial importance of the heart has been the buildup of wastes. Like a bustling factory, the recognized for ages. However, the cardiovascular body must have a transportation system to carry system is much more than just the heart, and its various “cargoes” back and forth. Instead of from a scientific and medical standpoint, it is roads, railway tracks, and subways, the body’s important to understand why this system is so vital delivery routes are its hollow blood vessels. to life. Most simply stated, the major function of the Night and day, minute after minute, our tril- cardiovascular system is transportation. Using lions of cells take up nutrients and excrete wastes.
    [Show full text]