Effective Management of Anaesthetic Crises

Site of Injury

* Consider possibility of caval injury
* Upper body blunt trauma (? SVC injury)
Insert at least one lower limb infusion
* Abdominal trauma (? IVC injury)
Avoid lower limb infusion sites

Vascular Access Site Options

* Peripheral Vein
* Central Vein
* Intraosseous

Peripheral Vein

* Percutaneous: procedure of choice
Upper or lower limb or both
* Cut down: requires surgical expertise and complication rate similar to central cannulation
Long saphenous
Cephalic
Basilic
Median cubital
* Surgical access

Central Vein

* Use when peripheral routes are not available
* Complication rate increases with each needle pass
* Therefore no more than five attempts
* Routes:
Internal Jugular
External Jugular
Subclavian
Femoral

Internal Jugular Vein

* Familiar route for anaesthetists
* Avoid in cervical trauma
* Risk of carotid puncture
Avoid if you are concerned about cerebral perfusion

Subclavian Vein

* Risks:
Subclavian artery puncture
Pneumothorax
* Insert on the same side as chest drains in trauma patients

Femoral Vein

* Technically easy
* Can be performed at the same time as airway management / instrumentation
* A femoral arterial line can also be inserted while the groin is already prepped and draped
* Avoid in intra-abdominal trauma / IVC injury

Intraosseous

* Any age group but best in preschool age children
* Any non traumatised long bone but usually tibia
Tibia - anteromedial aspect 2cm below tibial tuberosity.
* Ideally an intraosseous needle but any large bore needle may be adequate
* Use a rapid volume infusion device
* Temporary route only