By Andy Bodenham, Helen Hamilton
This booklet addresses all of the matters a sufferer may possibly adventure sooner than receiving a VAD. collection of apparatus, useful elements of method, the professionals and cons of many of the veins, and alterations of procedure for definite conditions are tested. Covereage additionally contains the jobs performed by means of radiologists, anaesthetists, surgeons, nurses, and different workforce memebers. in the course of the chapters a reference is made to the IV treatment criteria released by way of the Royal collage of Nursing IV treatment discussion board in 2003. every one bankruptcy is proof established and entirely referenced.
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Extra info for Central Venous Catheters
Nucleus 27 28 Applied anatomy of the central veins Choosing the best approach to the best vein Choosing the best vein depends on many factors. These are influenced by both the patient characteristics and the purpose of the catheter to be inserted. The following major factors should be taken into account: r Infection risk r Thrombotic risk r Risk of stenosis r Bleeding risk r Risk of pneumothorax r Ease of tunnelling and port access r Ease of insertion r Clinical stability r Experience and skill or operator r Availability and expertise in the use of ultrasound screening and X-ray Risk of infection (see also Chapter 13) Infections are more common in the femoral region than in other common approaches.
Thus poor technique, particularly during dilatation of the vein, can cause large defects with serious bleeding consequences. Adjacent structures Veins tend to run with other structures in the body, particularly arteries, nerves and lymphatic vessels, which are therefore automatically at risk of inadvertent trauma when the vein is approached with a needle (see Chapter 12). 12 Stylised diagram of cross-section of vein wall. 13 Longitudinal aspect of vein wall. Nucleus 27 28 Applied anatomy of the central veins Choosing the best approach to the best vein Choosing the best vein depends on many factors.
Formal radiological assessment of the great vessels of the thorax/abdomen may be required prior to CVAD insertion, particularly if there is a history of difficult procedures in the past or clinical evidence suggests abnormalities may be present. 9), pacemakers, venous stenosis or tumours invading the central venous system (see radiology and Chapters 10 and 11). Laboratory assessments Biochemical assessment Recent serum electrolytes should be within the normal range prior to insertion of a CVAD, in particular potassium, which if low or high may increase the risk of arrhythmias.