Vascular Access In Clinical Practice

This comprehensive reference details the techniques for establishing vascular access for hemodialysis and other acute and chronic conditions that require access to the circulation along with peritoneal dialysis access methods. Includes over 960 references and more than 160 tables, figures, and photographs. Vascular Access in Clinical

This book focuses on the placement of vascular access devices under emergent conditions, including the techniques and devices needed to achieve successful device deployment in even the most critically-ill patient. Up-to-date references and evidence for best practices are provided, informing both the novice and experienced healthcare provider. Each chapter is meticulously researched, including individual chapters focusing upon peripheral intravenous, intraosseous, central venous, and ultrasound-guided catheter placement. Device selection and emergent decision-making are discussed at length, including such crucial determinants as infusion flow rates, device limitations, issues with medication incompatibility, complications of line placement, and the relative indications and contraindications associated with various vascular access approaches. Emergent Vascular Access is an essential resource for any healthcare provider who places or manages vascular access devices in critically-ill patients, including emergency and ICU physicians, residents, rapid response providers, EMS paramedics, patient care technicians, medical students, and nurses.

This Open access book offers updated and revised information on vessel health and preservation (VHP), a model concept first published in poster form in 2008 and in JVA in 2012, which has received a great deal of attention, especially in the US, UK and Australia. The book presents a model and a new way of thinking applied to vascular access and administration of intravenous treatment, and shows how establishing and maintaining a route of access to the bloodstream is essential for patients in acute care today. Until now, little thought has been given to an intentional process to guide selection, insertion and management of vascular access devices (VADs) and by default actions are based on crisis management when a quickly selected VAD fails. The book details how VHP establishes a framework or pathway model for each step of the patient experience, intentionally guiding, improving and eliminating risk when possible. The evidence points to the fact that reducing fragmentation, establishing a pathway, and teaching the process to all stakeholders reduces complications with intravenous therapy, improves efficiency and diminishes cost. As such this book appeals to bedside nurses, physicians and other health professionals.

Winner of a COMMENDED AWARD in the Urology category of the 2008 BMA Medical Book Competition. Following on from the huge success of the first edition, this is the second edition which will not only update all previous chapters but also, it will have many additional chapters to add value over and above the first edition. The need for dialysis access surgery is growing rapidly as the population of patients with endstage renal failure expands. This book is aimed at those healthcare professionals involved in the care of patients undergoing dialysis. Vascular Access Simplified gives a comprehensive review of all aspects of adult dialysis access with a specific emphasis on haemodialysis. The text highlights some of the difference in practices of physicians in Europe and the USA. The contributors are allied professionals, physicians, radiologists, vascular and transplant surgeons who have a specific interest and are all committed to improving the quality of dialysis access.

This practical and comprehensive book provides "how-to" information on all aspects of access to the vascular system for hemodialysis, parenteral nutrition, chemotherapy, and resuscitation. Preoperative evaluation, operations, noninvasive procedures, complications, and other aspects are detailed. This edition provides increased coverage of non-interventional techniques and includes new chapters on management of thrombophilia in hemodialysis patients; modulation of the immune system to prevent myointimal hyperplasia; synthetic grafts; venous outflow stenting for salvage of vascular access procedures; and ultrasound in vascular access procedures. This book is essential for all clinicians treating patients who require vascular access, including vascular surgeons, general surgeons, nephrologists, dialysis technicians and nurses, radiologists, and cardiologists.

Updated and revised, this 4th Edition is a practical, in-depth "how-to" guide to all aspects of vascular access surgery for a wide rage of patients and conditions. For each application, it illustrates regional anatomy and physiology ... discusses the indications for the various techniques... describes surgical procedures in depth...details the newest percutaneous interventions and thrombolysis...and presents the expected results and complications. Readers will also vital information on biomaterials, physiology of hemodialysis, and other core scientific topics.

Central venous catheters (CVC) are vital for patients receiving chemotherapy not compatible with peripheral infusion. Thousands of centrally and peripherally inserted central venous catheters are inserted into patients with cancer each year. All types of intravascular catheters are associated with complications. These complications may be divided into infectious, thrombotic, mechanical and occlusive events. All of these events have the potential to harm patients and cause additional expense for the health-care system. Furthermore, the above-mentioned complications are largely avoidable through proper patient selection, insertion technique, hygiene precautions and catheter maintenance. Catheter-related infections and deep venous thrombosis are the two most common and feared CVC related complications. Infection in a catheter can cause lifethreatening bacteraemia, and thrombosis can lead to pulmonary embolisation, post-thrombotic syndrome and stenosis of the vessel affected. Many studies describing methods to minimise infectious complications associated with central venous catheters have been carried out. These methods appear to have been implemented in most modern advanced healthcare facilities resulting in a continual decrease in catheter-related infections over the last two decades. New implantation techniques, fewer infections and better catheter materials are likely to have contributed to the reduction in the incidence of catheter-related deep venous thrombosis (CR-DVT). Peripherally inserted central venous catheters (PICC) and subcutaneously implanted vascular access ports (PORT) are two very commonly used catheter devices for delivery of chemotherapy. International guidelines are unclear as to which device to choose due to the paucity of controlled trials. The aim of this thesis was to study complications related to central venous access devices used over long periods of time, usually for the delivery of chemotherapy. Vascular access in cancer patients – clinical implications We prospectively studied PORT complications (Study 1) over a six-month follow- up period. In Study 2, we assessed the number of common CVC-related micro- organisms that are transferred across PORT membrane contaminated by a controlled suspension of micro-organisms when a non-coring access needle is inserted using two different techniques. In the largest randomised controlled trial published on this topic (Study 3), we compared PICC with PORT regarding CRDVT and other catheter-related complications. The economic implications of using PICC or PORT were assessed from health-care system´s perspective (Study 4), using data on adverse events and clinical factors (implantation, treatments and dwell-time) from Study 3. Chemotherapy against various forms of cancer is very common. Implantation of PORT is one of the ten most common surgical procedures in Sweden according to the Swedish Perioperative Register. Hence, the topic in this thesis may be clinically relevant to many patients and their health care providers. We found that the incidence of catheter-related blood stream infection was very low in the cohorts studied. In general, PICCs are associated with significantly more CR-DVTs and adverse events than PORTs. The cost to the health-care system when using PICC is higher than for PORT when complications are included. Given the choice, patients about to commence chemotherapy appear to prefer PORT to PICC. PORT implantation is more painful than PICC insertion, but PICC appears to influence activities of daily life more than PORT.