Catheter placement

Subclavian and internal jugular ° Must verify catheter placement... 

Upon stabilization, placement of a pulmonary artery (PA) catheter may be indicated based on the need for more extensive cardiovascular monitoring than is available from non-invasive measurements such as vital signs, cardiac rhythm, and urine output.9,10 Key measured parameters that can be obtained from a PA catheter are the pulmonary artery occlusion pressure, which is a measure of preload, and CO. From these values and simultaneous measurement of HR and blood pressure (BP), one can calculate the left ventricular SV and SVR.10 Placement of a PA catheter should be reserved for patients at high risk of death due to the severity of shock or preexisting medical conditions such as heart failure.11 Use of PA catheters in broad populations of critically ill patients is somewhat controversial because clinical trials have not shown consistent benefits with their use.12-14 However, critically ill patients with a high severity of illness may have improved outcomes from PA catheter placement. It is not clear why this was... 

Fungal endocarditis is quite uncommon but has significant mortality, typically affecting patients who have had cardiovascular surgery, received a prolonged course of broad-spectrum antibiotics, have long-term catheter placement, are immunocompromised, or are IVDUs.8,35 Survival rates have remained... 

Central PN refers to the administration of PN via a large central vein, and the catheter tip must be positioned in the vena cava. Central PN allows the infusion of a highly concentrated, hypertonic nutrient admixture. The typical osmolarity of a central PN admixture is about 1500 to 2000 mOsm/L. Central veins have much higher blood flow, and the PN admixture is diluted rapidly on infusion, so phlebitis is usually not a concern. Patients who require PN administration for longer periods of time (greater than 7 days) should receive central PN. One limitation of central PN is the need for placement of a central venous catheter and an x-ray to confirm placement of the catheter tip. Central venous catheter placement may be associated with complications, including pneumothorax, arterial injury, air embolus, venous thrombosis, infection, chylothorax, and brachial plexus injury.1,20... 

Mechanical complications of PN are related to catheter placement and the system and equipment used to administer PN. A central venous catheter must be placed by a trained professional, and risks associated with placement include pneumothorax, arterial puncture, bleeding, hematoma formation, venous thrombosis, and air embolism.1,20 Over time, the catheter may require replacement. Problems with the equipment include malfunctions of the infusion pump, intravenous tubing sets, and filters. 

In both of these cases reasonable precautions had been taken to ensure correct catheter placement, but nevertheless systemic toxicity occurred. However, neither patient had any serious cardiotoxicity. However, it is worth emphasizing that large doses of local anesthetics should be given slowly and in divided doses and that lidocaine, one of the least toxic of the commonly used local anesthetics, has more obvious prodromal symptoms than ropivacaine, and could be a useful marker for intravenous injection (9). 

The placement of the exit site of the catheter is one of the factors related to the development or prevention of exit-site infections and peritonitis. Many new catheters and surgical techniques for catheter placement have recently been developed. The driving forces for this... 

Figure 4. Correlation of thrombus platelet concentration and thrombus weight. The positive correlation suggests that thrombus weight can be predicted from the number of platelets retained. These thrombi were retrieved 2-3 h after catheter placement. Conditions m =0.80 and r = 0.90.

The nurse should assess the intravenous catheter placement prior to administering the medication. If there is a blood return, the catheter is in the vein. 

Dinkel H-P, Triller J (2002) Pulmonary arteriovenous malformations embolotherapy with superselective coaxial catheter placement and filling of venous sac with Gug-lielmi detachable coils. Radiology 223 709-714... 

Hunt D, Sloman G. Long-term electrode catheter placement from coronary sinus. Br Med J 1968 4 495 96. 

In some cases, identification of a lateral venons branch in which to place a left ventricular lead is not immediately visualized. Most commonly, this is because either an insufficient mount of dye retrogradely filled aU venous branches due to poor balloon occlusion, the balloon itself occlnded the proximal aspect of an eligible lateral vessel, or another more proximal branch was not visualized due to distal balloon or angiographic catheter placement. In these cases, withdrawing the sheath to the ostium of the coronary sinns and performing a hand injection at this location will often identify a vessel snpplying the lateral wall when none was previously seen. 

Femoral vein (89-95%) Quickly and easily cannulated Very uncomfortable immobilization of leg required High rate of venous thrombosis (25-35% after 24 h) Fluoroscopy required for catheter placement... 

In certain sitnations the internal jugular or subclavian veins may be inaccessible or the patient may have uncorrectable thrombocytopenia or coagulopathy, which necessitates access to the central venous system by the femoral vein. When using this approach for temporary pacing, fluoroscopy is required for pacing catheter placement. In addition to the need for fluoroscopy, other disadvantages include patient comfort (because the leg cannot be bent at the hip), increased risk of infection, and poor catheter stability. 

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