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Alternative Approaches & Troubleshooting Tips
Difficult Vascular AccessAlternative Approaches & Troubleshooting TipsMichelle Lin, MDAssociate Professor of Clinical Emergency MedicineUC San Francisco - San Francisco General are many pieces of the puzzle to achieve success in obtaining vascular access in difficult cases. Choosing the best vascular site Implementing ultrasound technology Troubleshooting tipsCase #140 y/o man c/o chest pain and peaked T waves on EKG. He is a known dialysis patient with poor vascular access . You are unable to obtain a peripheral IV in his arms or do you try next to get rapid vascular access ?PictureV2V3V4V5V6V1 Adapted from Netter s Atlas of Human Anatomy, 1989 ExternalJugularSternocleidomastoidMuscle External Jugular VeinPositioning Trendelenburg Slight neck rotation to stretch the veinExternal Jugular VeinTechnique Valsalva maneuver Shallow angle needle (5-10 degrees)External Jugular VeinTechnique Reduce vein-rolling (bifurcation site or side-puncture)External Jugular VeinExternal Jugular VeinPearls May not have flashback of blood in catheter Floating the IV technique Secure the IV around the earPearls May not have flashback of blood in catheter Floating the IV technique Secure the IV around the earExternal Jugular Vein Medial and lateral to brachial artery Most
Central Venous Access Bottom line about choosing a site Subclavian lines are best. IJ lines are ok for short-term (<7 days) despite higher catheter colonization rate, because of …
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