Venous catheter indwelling

Vascular inujury Major orthopedic surgery (e.g., knee and hip replacement) Trauma (esp. fractures of the pelvis, hip, or leg) Indwelling venous catheters... 

As in the human studies, CCK-4 and other peptides must be given to primates intravenously to compensate for the short half-life, but the behavioral stress of short-term administration would confound behavioral observations. The implantation of an indwelling venous catheter that is protected by a jacket and swivel assembly allows administration of peptide or placebo without handling or alerting the animals. Behavioral observations may be made both immediately and from videotape records habituation and daily observations minimize nonspecific behavioral effects. In our own studies, monkeys typically receive placebo, CCK-4, or an analogue intravenously every second or third day but are often videotaped every day. 

The rats are fasted for about 4 h and are anesthetized with 80 mg/kg bw Ketamin plus 5 mg/kg Midazolam administered intravenously into the tail vein via an indwelling venous catheter. The amount corresponds to a volume of about 0.3 mL. Anesthesia is monitored by checking the reflexes and is maintained by repeat dosing of ketamine/midazolam. 

Second- or third-degree burns greater than 10%-20% TBSA or patients with significant smoke inhalation injury will require fluid resuscitation. Peripheral IV catheters can be used, but placement of a central venous catheter is optimal. An indwelling urine catheter should be placed so that output measures can he used to monitor the status of fluid resuscitation. 

Children with special health care needs will require additional considerations during mass casualty or disaster care. These considerations include decontamination procedures following radiation or chemical exposure for children using wheelchairs, ventilators, or oxygen and decontamination procedures for children with gastrostomy tubes, tracheostomy tubes, indwelling bladder catheters, and indwelling central venous catheters. Replacement supplies would be needed once the cutaneous decontamination is completed. Such supplies may not be readily available, so provisions must be made to secure these items or to have comparable clean or sterile supplies on hand. 

VTE in children has become increasingly common secondary to prematurity, cancer, trauma, surgery, congenital heart disease, and SLE. Children often develop DVTs associated with an indwelling central venous catheter. In contrast to adults, children rarely develop idiopathic VTE. 

Catheter device selection is based on a number of factors, including the plarmed application and placement site, duration of implantation, composition of fluids infused, and frequency of access (Namyslowski and Patel, 1999). Vascular catheters can be divided into two genei groups shortterm, temporary catheters that are placed percutaneously, and long-term, indwelling vascular catheters that usually require a surgical insertion. Temporary catheters include short peripheral venous and arterial catheters, nontunneled central venous and arterial catheters, and peripherally inserted central catheters (Pearson, 1996). Tunneled central venous catheters and totally implantable intra-... 

Hoshal, Jr., V. L., Ause, R. G., and Hoskins, P. A., Fibrin sleeve formation on indwelling subclavian central venous catheters, Arch. Surg., 1971 102(4) 353-358. 

A peripheral venous catheter or indwelling venous cannula (see Fig. 13.7) is the most commonly used vascular access. Often these infusion devices are named by their brand name such as Venflon marketed by BD or Brauniile marketed by B.Braun Melsungen. The cannula or peripheral venous catheter is inserted into a peripheral vein at the hand or the arm to administer infusion solutions... 

Clarke DE, Raffin TA (1990) Infectious complications of indwelling long-term central venous catheters. Chest 97 966 972... 

Weightman NC, Simpson EM, Speller DC, Mott MG, Oakhill A (1988) Bacteraemia related to indwelling central venous catheters prevention, diagnosis and treatment. Eur J Clin Microbiol Infect Dis 7 125-129... 

The indwelling central venous catheter should be maintained as an intravenous life-line. That the catheter should be used exclusively for delivery of the intravenous nutrient solution is inherent in this philosophy. The temptation to withdraw blood via the catheter, to use the catheter for frequent central venous pressure monitoring, to inject bolus medication via the catheter, or to use the catheter for blood or blood constituent administration must be repressed. Three-way stopcocks within the delivery system must be condemned, because maintenance of the sterility of any intravenous system containing a three-way stopcock is virtually impossible. 

Morbidity and mortality in HIT are related to thrombotic events. Venous thrombosis occurs most commonly, but occlusion of peripheral or central arteries is not infrequent. If an indwelling catheter is present, the risk of thrombosis is increased in that extremity. Skin necrosis has been described, particularly in individuals treated with warfarin in the absence of a direct thrombin inhibitor, presumably due to acute depletion of the vitamin -dependent anticoagulant protein C occurring in the presence of high levels of procoagulant proteins and an active hypercoagulable state. 

For monitoring of such vital functions as circulation, ventilation and acid base status in the critically ill child, indwelling venous or arterial catheters are necessary. To maintain patency of these catheters and to allow blood sampling, a small but finite volume of fluid is necessary. For optimal safe usage, isotonic saline or 57o dextrose in water solution is administered in a low constant volume and intermittent flushing with small bolus of fluid is carried out as necessary to maintain patency of the line. The caloric value of these fluids is low compared to standard parenteral alimentation solutions, yet in the very small infant, the volume constitutes a significant proportion of absolute water need. 

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