Beruflich Dokumente
Kultur Dokumente
vascular access
Hilman Ibrahim
Div. Of Vascular and Endovascular
FKUI/RSCM
Peripheral
venous catheter
Double lumen
catheter
Indication and
Contraindication
Indication
1.
Hemodialysis
2.
Chemotherapy
3.
Nutrition
4.
Fluid administration
5.
Drugs administration
6.
Blood transfusion
7.
Antiviral therapy
8.
9.
Angiology
Relatif
contraindication
Coagulopathy
Allergy to the catheter
material
Mediastinal tumor
Skin infection at
implantation site
Intra Arterial
Aortic Aneurysm
EVAR
Jugular vein
Subclavia vein
Brachial vein
Risks/Benefits of CVC
Placement
Indications for central
venous catheter (CVC)
Inadequate peripheral
vascular access
Need for frequent vascular
access
Hypertonic/hyperosmolar
infusions
Infusion of irritating or
vesicant drugs
Rapid absorption and
blood/tissue perfusion
Long-term IV therapy
Timing V.A :
Emergency : life saving
i.V Catheter
Temporery
Permanent
: HD access
Duration:
1.
2.
3.
4.
5.
Skin tunneled
CVC
Subcutaneous port
Short term/day
Long term/weeks, month/years
USG Doppler :
Blood Clot (bt,ct)
X-ray (fluoroscopy)
C-Arm
Mapping/anatomy
Assess the vein
- jugular vein
- subclavia
- femoral
- brachial
Pre Operative
Operative
Post Operative
Patient
Anamnesis/History
- Comorbid/Underlying Disease
-DM
- Arterioscleorosis
- Heart Failure
- Trauma Puncture / CDL
Physical Examination
- Trauma Puncture vein
- Edema
- Countour of vein Cephalic to subclavia
- Countour arterial
- Allen test
USG Doppler
-
thrombus
plaque
flow
USG
DOPPLER
Internal jugular
Femoral vein
Vascular Access
Match catheter size to patient size and anatomical site
Sites
Internal Jugular Vein
Femoral
Avoid subclavia vein if possible
Complications :
Infection
Heart failure
Distal ischemia
Aneurysm and pseudoaneurysm
Venous hypertension
Median nerve injury
Seroma formation
Complication of perypheral
Cannulation
Extravasation The
leakage of high
osmolarity solutions or
chemotherapy agents
can result in
significant tissue
destruction, and
significant
complications
Site Puncture
No Ideal Place VA
Venous Hypertension
Venous Hypertension
Port Implant
Catheter Rupture
- as empiric
- after result of culture or resistance
Algoritma
Vescia S, Baumgartner AK, Jacobs VR, Kiechle-Bahat M, Rody A, Loibl S,
Harbeck N. Management of venous port systems in oncology: a review
of current evidence. Annals of Oncology 19: 915, 2008
Percutaneous angioplasty
Corrects over 80% of stenosis
in both native fistulas and synthetic grafts
in both venous and arterial outflow tracts
Mr T,50 yo
central vein occlusion
Post Plasty
Venoplasty
TREATMENT OF THROMBOSES
The 2006 K/DOQI guidelines
With grafts and associated stenosis:
Surgical thrombectomy
Thrombolysis
Mechanical disruption
With fistulas:
no recommend any approach to the removal of thromboses
Surgical thrombectomy
Outpatient procedure
quick
very low complication rate
initially success in 90%
Thrombolysis
Attempts to fistula thrombosis with urokinase and
streptokinase, originally yielded disappointing results
Dosing adjustments and technical advances:
improved the success rate
reduced the incidence of bleeding
THANK
YOU