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Abstract

Obtaining or maintaining vascular access for continuous hemofiltration can sometimes be problematic, especially in the child or adult in multiple organ failure with edema and/or coagulopathy. Problems commonly encountered include obstruction of the femoral vein by the catheter, insertion difficulties, safety concerns when cannulating the subclavian vein in coagulopathy, and catheter and circuit occlusion due to disseminated intravascular coagulation. For access in infants we describe a technique utilizing two single-lumen thin-walled vascular sheaths. For infants and small children initial access to the vein may be difficult due to edema or poor perfusion. For this situation we describe the 'miniintroducer' technique of securing the vein and facilitating subsequent insertion of a relatively large guide wire. At any age an alternative route to the subclavian vein, from above the clavicle, is potentially 'compressible' in the event of hemorrhage during the procedure. We remind the reader of the utility of ultrasound guidance for cannulation of the internal jugular and subclavian veins. And lastly we review the options for venous return via the umbilical vein in infants, and via the antecubital vein in larger children and adults.

Development of a Modular Tissue Phantom for Evaluating Vascular Access Devices

“…Even using ultrasound guidance, it is oftentimes difficult to locate vessels due to loss of arterial pulse and vasoconstriction during hemorrhage [ 11 ]. Edema [ 12 ] and anatomical complexities can also obscure visualization. In pre-hospital settings with limited lighting and evacuation opportunities, this technique becomes even more challenging.…”

Skin Necrosis Distal to a Rapid Infusion Catheter: Understanding Possible Complications of Large-bore Vascular Access Devices

“…They are short, large-caliber (7 or 8.5 French (Fr)), peripheral catheters placed by upsizing existing traditional peripheral intravenous (PIV) catheters using a Seldinger technique (unpublished study on file at Arrow International, Incorporated: Cavallaro DL, Rosemurgy AS, Michlin JP, Bronleewe SH). RIC use is reported with great success in a broad variety of clinical settings and populations: trauma (adult and pediatric; civilian and military), code resuscitations, obstetric bleeding, and liver transplant cases are the most commonly cited [ 1 - 5 ]. RICs are appealing for their ease and speed of placement (conversion from an existing PIV catheter), their large caliber allowing for up to 750 mL/min infusion rates (unpublished study on file at Arrow International, Incorporated: Cavallaro DL), and their lack of central line-associated complications.…”