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Vascular access difficult

N LeVasseur, C Stober, K Daigle, A Robinson, S McDiarmid, S Mazzarello, B Hutton, A Joy, D Fergusson, J Hilton, M McInnes, M Clemons
Background: Despite advances in systemic therapy choices for patients with early-stage breast cancer, optimal practices for intravenous (IV) access remain unknown. That lack of knowledge holds particularly true for the use of central venous access devices (cvads) such as peripherally inserted central catheters (piccs) and implanted vascular access devices (ports). Methods: Using a survey of Canadian oncologists and oncology nurses responsible for the care of breast cancer patients, we evaluated current access practices, perceptions of complications, and perceptions of risk, and we estimated complication rates and evaluated perceived risk factors for lymphedema...
August 2018: Current Oncology
An Shkarubo, Kv Koval, Ma Shkarubo, Iv Chernov, Dn Andreev, Aa Panteleyev
INTRODUCTION: Until recently, tumors of the clivus and the anterior region of the posterior cranial fossa were considered extremely difficult to access and often inoperable using standard transcranial approaches. With the introduction into the neurosurgical practice of minimally invasive methods utilizing endoscopic techniques, it became possible to effectively remove hard-to-reach tumors, including central tumors of the anterior region of the posterior cranial fossa. OBJECTIVE: To present the basic topographic and anatomical features of the clivus and adjacent structures with an objective of possible improvements and optimization of the extended endoscopic endonasal posterior (transclival) approach when removing tumors of the clivus and anterior regions of the posterior cranial fossa...
August 7, 2018: World Neurosurgery
António Norton de Matos, Clemente N Sousa, Paulo Almeida, Paulo Teles, Duarte Rego, Gabriela Teixeira, Luís Loureiro, Sérgio Teixeira, Inês Antunes
Vascular access dysfunction is a serious problem in dialysis units. Some patients have complex dysfunctions that are difficult to resolve. In this article, we report the case a of two patients with radiocephalic arteriovenous fistulae (RC-AVF) who had stenosis/occlusion of the forearm median vein and where we used the basilic vein of the forearm as a solution. We reviewed the use of this surgical solution in RC-AVF. Two male patients on hemodialysis exhibited stenosis/occlusion of the forearm median vein. The forearm basilic vein was isolated and rotated toward the forearm median vein in order to solve RC-AVF problems...
July 25, 2018: Therapeutic Apheresis and Dialysis
Amit Bahl, Bophal Hang, Abigail Brackney, Steven Joseph, Patrick Karabon, Ammanee Mohammad, Ijeoma Nnanabu, Paul Shotkin
INTRODUCTION: Establishing peripheral intravenous (IV) access is a vital step in providing emergency care. Ten to 30% of Emergency Department (ED) patients have difficult vascular access (DVA). Even after cannulation, early failure of US-guided IV catheters is a common complication. The primary goal of this study was to compare survival of a standard long IV catheter to a longer extended dwell catheter. METHODS: This study was a prospective, randomized comparative evaluation of catheter longevity...
July 19, 2018: American Journal of Emergency Medicine
Mary E Mollie Meek, James C Meek, Blake Hollowoa, Ruizong Li, Linda A Deloney, Kevin D Phelan
RATIONALE AND OBJECTIVES: Competency in ultrasound (US) imaging and US-guided procedures is often difficult for medical students and residents to master. The use of simulation training has been strongly encouraged but the quality of phantom models available for US-guided procedures is limited. As a feasible alternative, we describe the innovative use of a lightly embalmed cadaver for realistic practice of common interventional radiology (IR) procedures prior to direct patient care. MATERIALS AND METHODS: Lightly embalmed cadavers were positioned as patients would be in the IR suite: supine, prone, and erect seated position...
July 14, 2018: Academic Radiology
G Trasimeni, F Laurino, D Lamusta, N Limbucci, S Mangiafico
We report a case in which navigation of the micro catheter (Headway 027) with the conventional single microwire technique became impossible because of the difficult intracranial vascular anatomy. In order to achieve access, we used two Terumo 012 inches micro guide-wires with a 45° angle inside a single micro catheter. The manoeuver was easy and can be reproduced in specific and challenging cases.
July 25, 2018: Journal of Neuroradiology. Journal de Neuroradiologie
Nicholas Inston, Charmaine E Lok
The timing of referral for creation of vascular access in a patient with declining kidney function is difficult to predict. Current methods may result in patients undergoing unnecessary procedures and subsequent interventions on accesses that are never used. Multiple variables, including time for assessment, surgery and follow-up that considers the likelihood of access failure, and the estimated rate of kidney function decline, make vascular access planning challenging and difficult to balance. Better prediction tools that incorporate the risks of progressive decline in kidney function with the risk of access failure and the competing risk of death would facilitate decision-making in vascular access...
July 1, 2018: Journal of Vascular Access
Meghan P Horn, Minhaj S Khaja, Emily Z Stucken, Wael E Saad
Tetra-amelia is a rare congenital disorder characterized by the absence of limbs. We describe the anesthetic management of a 29-year-old woman with tetra-amelia who underwent general anesthesia for tympanomastoidectomy with meatoplasty for an extensive right ear cholesteatoma. Anesthetic challenges related to tetra-amelia include difficult intravenous access, lack of sites for blood pressure monitoring, and possible difficult airway management due to craniofacial anomalies. Our case report focuses on the complex establishment of iliac artery access for invasive blood pressure monitoring by initially cannulating the carotid artery...
July 5, 2018: A&A practice
Noga Lipschitz, Gavriel D Kohlberg, Mario Zuccarello, Ravi N Samy
PURPOSE OF REVIEW: To review the current literature on the extended middle cranial fossa (xMCF) approach and to provide a comprehensive description of the relevant anatomy, indications, surgical technique, results, and complications. RECENT FINDINGS: The xMCF approach expands the surgical exposure provided by the sMCF approach, allowing access to the internal auditory canal, cerebellopontine angle, prepontine cistern, anterior petrous apex, petrous carotid artery, Meckel's cave, cavernous sinus, mid and upper clivus, and posterior lesions approaching the jugular foramen...
June 27, 2018: Current Opinion in Otolaryngology & Head and Neck Surgery
Barbara Smith Ehrhardt, Kelley E A Givens, Rebecca C Lee
: Background: Establishing peripheral IV access for infusions is one of the most common invasive procedures performed in the hospital setting, but it isn't always successful on the first attempt. Multiple attempts delay treatment and cause stress in patients and nurses. The literature reports that venipuncture skills are among the most challenging for novice nurses to master. OBJECTIVES: The goal of this quality improvement (QI) initiative was to develop, validate, and refine a simple evidence-based tool that novice nurses can use in the clinical setting to better identify those patients with preexisting conditions or anatomical variances that result in difficult IV access...
July 2018: American Journal of Nursing
L Ciércoles Ramírez, M Batllori Gastón, M E García Tinoco
Central venous cannulation is a commonly performed procedure in the hospital setting, while the internal jugular vein is one of the most frequently used to perform central venous access. The presence of venous valves in the jugular veins is a well-known fact, albeit often neglected during central venous cannulation. However, venous valves can make this procedure difficult, increasing the chance of developing complications. We report the case of a patient in whom the presence of a valve in the internal jugular vein did not permit a vascular access to be obtained through this vessel...
June 26, 2018: Anales del Sistema Sanitario de Navarra
I N Shchanitsyn, M R Sharafutdinov, R A Iakubov, I V Larin
A femoral approach is the main access in stenting of carotid arteries, mainly due to rapid training in how to perform the procedure and a possibility of using large-diameter catheters. However, this approach is not always feasible in atherosclerosis, tortuosity of lower-limb arteries and in certain anatomical peculiarities of the aortic arch. Using a transradial approach is based on the desire to diminish the incidence rate of haemorrhagic complications in the zone of the puncture and to avoid the necessity of a long-term bed rest...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Nicolas W Villelli, David M Lewis, Thomas J Leipzig, Andrew J DeNardo, Troy D Payner, Charles G Kulwin
OBJECTIVE Intraoperative angiography can be a valuable tool in the surgical management of vascular disorders in the CNS. This is typically accomplished via femoral artery puncture; however, this can be technically difficult in patients in the prone position. The authors describe the feasibility of intraoperative angiography via the popliteal artery in the prone patient. METHODS Three patients underwent intraoperative spinal angiography in the prone position via vascular access through the popliteal artery. Standard angiography techniques were used, along with ultrasound and a micropuncture needle for initial vascular access...
June 15, 2018: Journal of Neurosurgery. Spine
Alonso Turrent-Carriles, Juan Pablo Herrera-Félix, Mary-Carmen Amigo
Antiphospholipid syndrome is a complex autoimmune disease, characterized by the presence of vascular thrombosis, obstetric, hematologic, cutaneous, and cardiac manifestations. Renal disease in patients with antiphospholipid syndrome was not recognized in the first descriptions of the disease, but later on, the renal manifestations of the syndrome have been investigated widely. Renal manifestations of antiphospholipid syndrome conform a wide spectrum of diverse renal syndromes. Hypertension is one of the most frequent, but less commonly recognized renal alteration...
2018: Frontiers in Immunology
Rosario Spina, Baudolino Mussa, Lara Tollapi, Fabio Conti, Enrico Cortesi, Roberto Verna
Vascular access is the commonest invasive procedure in secondary care. Vascular access is understood as being access to the bloodstream of acute and chronic patients for diagnostic and therapeutic purposes such as blood sampling, vessel pressure monitoring, fluid infusions (blood transfusions, parenteral nutrition), pharmacological treatments (e.g. antibiotic therapies, chemotherapy, analgesic therapies) or apheresis/dialysis through catheters that may remain in the vessels for weeks or months. There is a wide variety of options available for venous access...
June 2018: Minerva Medica
Kim Marie C Macygin, Erik Kulstad, Robert K Mokszycki, Morgan Goldsmith
Health care providers are increasingly challenged to balance cost considerations for devices, drugs, and staffing all while continuing to provide excellent care. Patients in both the post-acute and acute care settings often require fluid and/or medication when their oral route is compromised and vascular access may not be warranted or immediately accessible. The rectum is an underutilized administration point that can be accessed with speed and relative ease. Areas Covered: Literature reviews of pharmaceutical, medical, and nursing references reveal current and historical science that validates the rectal route as a means of alternative administration for fluids and medications...
June 2018: Expert Review of Medical Devices
R Pálek, V Liška, L Eberlová, H Mírka, M Svoboda, S Haviar, M Emingr, O Brzoň, P Mik, V Třeška
INTRODUCTION: Corrosion casts (CCs) are used for the visualization and assessment of hollow structures. CCs with filled capillaries enable (with the help of imaging methods) to obtain data for mathematical organ perfusion modelling. As the processing is more difficult in case of organs with greater volume of the vasculature, mainly organs from small animals have been cast up to now. The aim of this study was to optimize the protocol of corrosion casting of different organs of pig. Porcine organs are relatively easily accessible and frequently used in experimental medicine...
2018: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Hugo Silva, Andreia Fernandes, João Rodrigues, Daniel Brandão, Manuela Vieira, Catarina Celestino
INTRODUCTION: Endovascular aortic interventions are suitable alternatives to open surgery, being less invasive and having lower mortality and complications. Accurate positioning of the stent graft is a critical point because of systolic thrush. Techniques used to prevent it include pharmacological (antihypertensive drugs, nitroglycerin, adenosine) and mechanical methods (temporary caval occlusion by balloon). Rapid Right Ventricular Pacing (RRVP) is an emerging alternative with good patient tolerance and low level of complications...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Pedro Pinto Sousa, Paulo Almeida, Pedro Sá Pinto, Rui Almeida
INTRODUCTION: Creating and maintaining a functional vascular access(VA) is a critical factor in the survival of a dialysis patient. However, it will not function forever, implying a creative attitude from the vascular surgeon either to maintain its functionality or built a new one wherever possible, being it autologous or synthetic. METHODS: Describe the VA history of a 59years-old male with morbid obesity and end-stage chronic kidney disease. RESULTS: His VA construction started in2012 with failed attempts in both forearms until a functional brachiocephalic artery-venous fistula(AVF) in the right upper limb was achieved, but was deemed to ligation as severe venous hypertension secondary to central venous disease related to CVC use...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Arshad M Khanani, David Eichenbaum, Patricio G Schlottmann, Lisa Tuomi, David Sarraf
PURPOSE: This review aimed to determine the optimal management of retinal pigment epithelial detachments (PEDs) in neovascular age-related macular degeneration (nAMD) based on review of available evidence in the literature. METHODS: A comprehensive literature review evaluates previous retrospective and prospective studies that assessed the treatment of PEDs in nAMD. RESULTS: Studies illustrated that anti-vascular endothelial growth factor (VEGF) therapy can be effective in eyes with PED secondary to nAMD...
April 24, 2018: Retina
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