Arterial access

Minor to major bleeding complications may occur, most commonly at arterial access site for cardiac catheterization. 

Signs and symptoms of overdose include generally minor mucocutaneous bleeding and bleeding at the femoral artery access site. 

Most major bleeding occurs at arterial access site for cardiac catheterization prior to pulling femoral artery sheath, discontinue heparin for 3-4 hr and document activated clotting time (ACT) <180 sec or aPTT <45 sec achieve sheath hemostasis >4 hr before discharge... 

Clearance procedures can be conducted in all laboratory animal species anesthetized and conscious animal models may be used. Measurement of arterial pressure is advisable, especially in anesthetized preparations, to insure that renal perfusion pressure remains within the autoregulatory range (usually 80-120 mmHg). Vascular access ports can be helpful to provide continuous arterial access for pressure measurements (Mann et al. 1987). 

In traumatic bleeding in the area of the liver, haemostasis may be performed within the framework of diagnostic arteriography by means of embolization. Arterial access likewise facilitates embolization and cytostatic treatment of liver tumours (following angiographic insertion of the catheter), (s. tab. 8.4)... 

When embolotherapy is indicated, the patient is transferred to an angiographic suite. Intensive care physicians should be present during the procedure. Right femoral artery access is obtained, and a 4-or 5-F sheath is inserted. Additionally, left femoral venous access may be obtained to be used by the intensive care physician if no other central access is available for supportive therapy. 

The ipsilateral uterine artery access is obtained using the Waltman loop. When the angle of aortic bifurcation is too tight, again the use of a sidewinder allows for easy catheterization. 

The right common femoral artery is the most conunon site for arterial access. It is the most familiar and tends to be the most comfortahle for the operator. Usually the entire procedure can he easily performed from a single arterial puncture. The contralateral artery is certainly very easy to approach with a C2 catheter as described above. The ipsilateral artery can be more difficult, particularly if a long, reversed curve catheter is not used. Occasionally the patient s anatomy will require the other femoral artery to be accessed. 

Needleless systems— Devices do not use needles for the collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established. 

D. Mago, M. Thomas, J. Stewart, W. RoUefson, E Flaherty, B. Murphy and E Ribeiro, A poly-N-acetyl glucosamine hemostatic dressing for femoral artery access site hemostasis after percutaneous coronary intervention a pilot stndy . Journal Invasive Cardiology, vol. 22, no.l, pp. 35-39, Jan. 2010. 

Table 19.3 A poly-N-acetyl glucosamine hemostatic dressing for femoral artery access ...

Anatomic Consideration The internal iliac arteries, the blood supply to the viscera of the true pelvis, are readily approached after femoral arterial access. The ipsilateral internal iliac artery is usually catheterized with a reverse curve catheter configuration and the contralateral internal iliac artery is usually accessed following passage over the aortic bifurcation with a forward seeking cobra catheter. On rare occasions because of atherosclerotic stenosis or occlusion of one femoral artery, two catheters (4-5 F) can be... 

LA. Infusion The angiographic catheters used for pediatric arterial infusion should be the smallest caliber possible. We often use 4-F catheters and gain initial femoral artery access with 4-F micropuncture systems. These access systems use a 21-gauge needle and an 0.018-in. guidewire for initial arterial entry. A two-part transition dilator is used to scale up the access to accept an 0.035-in. guidewire for which a 4-F catheter can be inserted. On occasion, ultrasound-guided arterial access can be used especially when spasm has occurred and the pulse is difficult to palpate. 

Since C-arm CT is usually performed in an interventional setting, intra-arterial access is typically available. As a consequence, selective intra-arterial contrast injections can be used to enhance vessels as well as corresponding tissue regions during C-arm CT data acquisition. 

Indications may be 3D imaging of contrast-enhancing intracranial tumors such as mengingiomas, non-invasive follow-up, e.g., for patients who obtained stent-assisted intracranial angioplasty, or for cerebrovascular imaging when arterial access is problematic. Our pre-hminary data are promising, and further research is required. 

Cook Micropuncture sheath A very versatile sheath which can be used as primary vein or artery access set in preparation for angiography and/or embolization, or, as described above, as a direct access device, e.g., in the treatment of a VVM. 

A femoral approach is preferred. If the side of the pelvic injury is known, the contralateral femoral artery should be used. This is because it is easier to catheterize 2nd- and 3rd-order vessels on the contralateral side, over the aortic bifurcation. If bilateral femoral artery access is impaired, an axillary or brachial approach can be used. An upper extremity... 

If the aneurysm is amenable to direct percutaneous puncture, another option includes direct thrombin injection or coiling via an 18-gauge needle. Simultaneous balloon occlusion of the aneurysm neck via arterial access can be performed to prevent nontarget embolization. 

A 4 Fr access set can be used in cases where less traumatic arterial access is needed (i.e. slightly abnormal coagulation profile, severe peripheral vascular disease), however smaller catheters may be a bit less controllable. 

Obtaining arterial access 18-g single-wall needle (Cook ) and 0.035 guide wire (Bentson, Cook) Micropuncture set (Cook)... 

Maintaining arterial access 5 Fr, 11-cm vascular sheath (Cordis ) 4 Fr, 11-cm vascular sheath (Cordis)... 

Access site complications are unusual as a large-diameter common femoral artery access is rarely required for the embolization. Iatrogenic arterial dissection occasionally occurs at the celiac artery origin during difficult catheterization. In patients with borderline hepatic or renal function, the risk of contrast induced nephropathy and hepatorenal syndrome can usually be prevented with optimal hydration and by limiting the volume ofliver embo-lized. 

Heparinization is usually recommended when coaxial catheter assembly systems are used to prevent fibrin clot formation. Initial prothrombin time, partial thromboplastin time and activation coagulation time is recommended to use as a baseline to calculate the dose of the protamine sulfate dosage when heparinization is to be reversed. Complete heparinization of the patient can be achieved with a bolus dose (50 lU/Kg) and a maintenance infusion (500 UI/Kg in 24 hours) that is initiated once the arterial access is obtained. 

Needleless systems devices that do not use needles for the collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established Negative pressure a condition caused when less air is supplied to a space than is exhausted from the space air pressure in the space is less than that in surrounding areas Negligence failme to do what reasonable and prudent persons would do under similar or existing circumstances... 

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