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Peripheral Vascular Access (peripheral + vascular_access)
Selected AbstractsUltrasound-assisted peripheral vascular access in a paediatric EDEMERGENCY MEDICINE AUSTRALASIA, Issue 2 2010Ed Oakley Abstract Objectives: To assess the implementation and utility of US for assisting peripheral venous access in a paediatric ED. Methods: A prospective, observational study of a convenience sample comparing the landmark and US-guided technique for peripheral vascular access in children from July 2006 to February 2007. Clinicians involved under went 3 months of training in US physics and with practical models. Clinicians estimated the degree of difficulty of insertion (using a Likert scale) before each line placement. Data including time of procedure and success or failure were collected, using a standardized clinical record form, by an observing researcher. Results: A total of 84 patients were enrolled. There were 61 line placement episodes in the landmark group (with 253 attempts), and 38 in the US group (with 90 attempts). US recorded slightly higher success per attempt overall (42% vs 38%, P= 0.08), and performed better in the patients with difficult access (success 35% vs 18%, P= 0.003). US attempts took longer than landmark attempts (2 min 15 s vs 4 min, P < 0.001). Conclusion: The US guidance may improve the success rate of peripheral vascular access in children rated to have difficult or very difficult vascular access. [source] Extracorporeal photopheresis with permanent subcutaneous right atrial cathetersJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 12 2007Hartmut Ständer Summary Background: Adequate peripheral venous access is crucial for successful extracorporeal photopheresis (ECP). As this approach is not always feasible in older patients and patients with graft-versus-host disease, central venous catheters play an increasing role in providing long-term vascular access for ECP.However, not all catheters are able to deliver the minimum flow rate of 7 ml/min for ECP. Patients and Methods: Eight different permanent subcutaneous right atrial catheters were connected in vitro to the UVAR® -XTSÔ photopheresis system and median flow rates were determined. In addition, in vivo flow rates of patients who received ECP, using either peripheral or central venous access, were determined. Results: Hemodialysis catheters with an internal diameter of 2.0 or 1.5 × 3.5 mm and a length up to 48 cm provided in vitro flow rates of 27,28 ml/min, almost identical to a peripheral access needle. Central venous catheters with a length of over 90 cm reached flow rates below 7 ml/min and are impractical for ECP. The analysis of 308 ECP collection cycles with peripheral vascular access revealed an average flow rate of 31.5 ± 6.4 ml/min. Only permanent subcutaneous right atrial catheters made for hemodialysis provided similar flow rates (Quinton PermCath Dual Lumen) (33.7 ± 4.7 ml/min, n = 198). Conclusions: Permanent subcutaneous hemodialysis catheters with a length of maximally 48 cm achieve optimal flow rates for ECP. They represent therefore the central venous access of choice in patients with inadequate peripheral vascular access. [source] Peripheral blood stem cell collection in pediatric patients: Feasibility of leukapheresis under anesthesia in uncompliant small children with solid tumors ,JOURNAL OF CLINICAL APHERESIS, Issue 2 2006Fernando Ravagnani Leukapheresis demands patient's compliance and adequate vascular accesses, which can require invasive methods in very small children whose treatment protocol includes hemopoietic stem cell collection for myeloablative chemotherapy and stem cell rescue. Since 1998, at the Istituto Nazionale Tumori of Milan, in selected uncompliant small children, the placement of peripheral vascular accesses and leukapheresis have been performed at the same time under general anesthesia. Peripheral venous cannulas were positioned for blood collection, while blood was returned through either peripheral cannulas or mono-lumen central catheters previously installed for chemotherapy. A continuous-flow cell separator was used for leukapheresis. Between 1998 and 2003, 47 children with solid tumors underwent anesthesia for a total of 54 leukaphereses. The patients' age ranged from 12.7 to 93 months (median 30.3) and their weight ranged from 7 to 20 kg (median 14.1). Neither metabolic nor anesthesiological complications were recorded. In 89% of cases, the CD 34+ cell target was achieved at a single harvest; the median number of CD 34+ cells was 10.8 × 106/kg/leukapheresis (range 1,117) and the median collection efficiency was 63.4% (range 25,100.6). Leukapheresis under anesthesia is feasible and safe in very low-weight children whose compliance is lacking due to age and disease. J. Clin. Apheresis, 2005 © 2005 Wiley-Liss, Inc. [source] | ||||||||||