Page 405 - Libro 2

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The Role of Ultrasound in Central Vascular Access Device Placement
Gail Egan Sansivero, Gary Siskin, and David Singh
OBJECTIVES
KEY TERMS
basilic vein | jugular vein | peripherally inserted central catheter | superior vena cava | vascular access device
GLOSSARY
air embolism inadvertent release of air or gas into the venous system
collateral veins preexisting veins that enlarge to take flow from neighboring but occluded vessels
fistula an abnormal connection or passageway between two organs or vessels; may be created due to trauma, or intentionally for therapeutic purposes
gain the brightness of an ultrasound image, which can be manipulated on most devices
glidewire a hydrophilic guidewire
guidewire a Nitinol or stainless steel wire used to support sheath or catheter exchanges and to predict vessel patency; measured in diameter and length
infiltration leaking of IV fluid from a catheter into the tissue surrounding the vein
intima innermost layer of a vein or artery; com- posed of one layer of endothelial cells in contact with blood flow; also known as the tunica intima
Central venous access plays a vital role in the care of critically ill patients as well as in patients requir- ing intravenous antibiotic therapy, central venous pressure monitoring, and sampling, hemodialysis, chemotherapy, and total parenteral nutrition. Vascu- lar access devices (VADs) are catheters that allow
microintroducer small needles and wires used to make the initial access into a target
peel away sheath a sheath that is perforated along the long axis, allowing the device to be split for removal from a catheter
PICC a peripherally inserted central catheter; a type of vascular access device that is typically inserted into a vein of the upper extremity and threaded to achieve a tip location in the distal third of the superior vena cava
pneumothorax a collection of air in the pleural space (between the lung and chest wall)
sheath a thin-walled, hollow plastic tube through which wires and catheters can be advanced; measured in French size according to the size of catheter it can accommodate (e.g., a 5-Fr sheath will allow a 5-Fr catheter to be passed through it)
stenosis narrowing of a vein or artery due to disease or trauma
clinicians to infuse medications and blood compo- nents, obtain blood samples, and deliver other ex- change therapies. Some patients may require only short-term access, whereas others are dependent on central vascular access for a lifetime. Central VADs are catheters placed so that the terminal tip of the
Describe the different types of vascular access device options
List the various veins that can be accessed for placement of a central line
Describe the ultrasound techniques used to obtain venous access
Define the potential complications of central venous access
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