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Alternative techniques for gaining venous access. What to do when peripheral intravenous catheterization is not
J J Vyskocil1, J A Kruse, R F Wilson
1Wayne State University School of Medicine, Detroit.
The Journal of Critical Illness
|February 7, 1993
Summary
Establishing venous access for fluid administration in patients without typical IV sites involves methods like limb elevation, nitroglycerin, and ultrasound. Cutdown procedures, while direct, are a last resort due to potential complications.
Area of Science:
- Emergency Medicine
- Vascular Access Techniques
Background:
- Patients lacking conventional venous access present a challenge for fluid administration.
- Various methods exist to establish alternative vascular access.
Purpose of the Study:
- To review therapeutic options for fluid administration in patients with difficult venous access.
- To discuss the role and risks of cutdown procedures for establishing uncommon venous sites.
Main Methods:
- Literature review of established and alternative venous access techniques.
- Discussion of ultrasonography and cutdown procedures for difficult access.
Main Results:
- Techniques include limb elevation, nitroglycerin ointment, blood pressure cuff inflation, and ultrasonography.
- Cutdown procedures offer direct access to deep veins (e.g., inferior epigastric, iliac) but are high-risk.
Conclusions:
- Cutdown procedures are a last resort for venous access, requiring specialized settings like operating suites.
- Potential complications of cutdown procedures include arterial puncture and hemorrhage.