Venous Accesses in Critically Ill Patients
Mohammed Ahmed Attia Hamada;
Abstract
Venous access is one of the most basic yet critical components of patient care in ICU. Safe and reliable venous access is an important issue in daily practice, and understanding the options and being able to counsel patients on appropriate devices is of growing importance.
There are a variety of options available for venous access.Basically there are two types of venous access, peripheral and central. Venous access device (VAD) selection must be tailored to each patient’s needs and to the type, duration, and frequency of infusion.
Peripheral intravenous (IV) lines are simple, inexpensive, and can be used for short-term IV therapy. Veins are typically accessed in the patient’s hand or arm, and sometimes in the foot. Intravenous lines must be replaced frequently, as the complication rates of infiltration and phlebitis increase dramatically with increased catheter dwell-time.
Central venous access is a commonly performed procedure with approximately 8 percent of hospitalized patients requiring central venous access during the course of their hospital stay. More than five million central venous catheters are inserted in the United States each year.
Central venous access is potentially lifesaving procedure. There are no absolute contraindications to perform it however; knowing which device is most appropriate for each situation might improve patient outcomes.
Aside from emergent placement of central lines, the indications for central catheters include, administration of IV fluids, medications, or blood products, either in large quantities or over a prolonged period of time; administration of medications that are harmful to peripheral veins (e.g., chemotherapy); long-term access to the central venous system for repeated procedures, such as blood sampling; and poor or inaccessible peripheral venous access.
Central venous access is also needed to place pulmonary artery catheters, plasmapheresis and hemodialysis catheters, as well as to place inferior vena cava filters, introduce wires for transvenous pacing and defibrillator devices, and for venous interventions. The central venous access site and manner in which access is achieved depends upon the indication for placement, patient anatomy, and other patient-related factors.
Ultrasound evaluation of veins is very valuable to ensure patency before venous puncture. Real-time ultrasound guidance has also been shown to reduce complications and improve technical success of central line placement.
There are a variety of options available for venous access.Basically there are two types of venous access, peripheral and central. Venous access device (VAD) selection must be tailored to each patient’s needs and to the type, duration, and frequency of infusion.
Peripheral intravenous (IV) lines are simple, inexpensive, and can be used for short-term IV therapy. Veins are typically accessed in the patient’s hand or arm, and sometimes in the foot. Intravenous lines must be replaced frequently, as the complication rates of infiltration and phlebitis increase dramatically with increased catheter dwell-time.
Central venous access is a commonly performed procedure with approximately 8 percent of hospitalized patients requiring central venous access during the course of their hospital stay. More than five million central venous catheters are inserted in the United States each year.
Central venous access is potentially lifesaving procedure. There are no absolute contraindications to perform it however; knowing which device is most appropriate for each situation might improve patient outcomes.
Aside from emergent placement of central lines, the indications for central catheters include, administration of IV fluids, medications, or blood products, either in large quantities or over a prolonged period of time; administration of medications that are harmful to peripheral veins (e.g., chemotherapy); long-term access to the central venous system for repeated procedures, such as blood sampling; and poor or inaccessible peripheral venous access.
Central venous access is also needed to place pulmonary artery catheters, plasmapheresis and hemodialysis catheters, as well as to place inferior vena cava filters, introduce wires for transvenous pacing and defibrillator devices, and for venous interventions. The central venous access site and manner in which access is achieved depends upon the indication for placement, patient anatomy, and other patient-related factors.
Ultrasound evaluation of veins is very valuable to ensure patency before venous puncture. Real-time ultrasound guidance has also been shown to reduce complications and improve technical success of central line placement.
Other data
| Title | Venous Accesses in Critically Ill Patients | Other Titles | التدخلات الوريدية فى مرضى الحالات الحرجة | Authors | Mohammed Ahmed Attia Hamada | Issue Date | 2015 |
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