Venous thromboembolism (VTE) is a major problem in patients in the intensive care unit (ICU), as previously analyzed ( Chapter 9 ). VTE will develop in approximately 12% of ICU patients despite appropriate prophylaxis. Furthermore, pulmonary embolism (PE) is common…
Overview Since its advent in 1977, percutaneous coronary intervention (PCI) has become a dominant treatment modality for ischemic coronary artery disease, especially unstable angina and acute myocardial infarction. During the last 2 decades, intravascular ultrasound (IVUS), a catheter-based technique that…
Overview Arterial catheterization is a frequent and essential procedure that is used in the intensive care unit (ICU) for accurate hemodynamic monitoring and repeated sampling of blood for analysis. Blind or palpated catheter insertion can be difficult because pulsations and…
Overview The concept of achieving central venous access by cannulation of a peripheral arm vein is old, although only in the last decade has the peripherally inserted central catheter (PICC) emerged as a safe and cost-effective option. In the last…
Ultrasound guidance to obtain vascular access has become increasingly more popular over the past decade. Advances in ultrasound technology have enhanced its ability to detect and interrogate smaller vascular structures for cannulation purposes. Given the potential complications that can develop…
General considerations and ultrasound evaluation of peripheral and central veins in pediatric patients (preprocedural scanning) Ultrasound offers the advantage of preprocedural evaluation of all possible venipuncture sites as detailed in previous chapters. This is an essential feature of the ultrasound…
Overview Standard central venous access performed with the “blind” technique was historically based on the puncture of two central veins (the subclavian vein and the internal jugular vein), but ultrasound (US) guidance has expanded the spectrum to at least four…
Ultrasound-guided vascular access (UGVA) was introduced in the preceding chapter. This chapter highlights a few tips for novices as well as additional techniques and innovations that would assist skilled operators in definitively identifying the target vessel and improving catheterization in…
Overview Central venous access is a core skill for anesthesiologists, intensivists, acute care physicians, and surgeons. It is indicated for fluid and drug administration, dialysis, and cardiovascular monitoring. More than 5 million central venous catheters (CVCs) are inserted annually in…
Background Venous thromboembolism (VTE) is a spectrum of disease that encompasses both deep venous thrombosis (DVT) and pulmonary embolism (PE). It is a serious and often underrecognized condition in critically ill patients that can lead to significant morbidity and mortality.…