Cardiovascular Emergencies - Vascular Access

Vascular Access

Aim: Intravascular Volume Restoration

Insert two cannulae of as large a bore as possible
Choice of site depends on:

Skill of personnel

Site of injury in trauma patients

Warm fluids to reduce hypothermia

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

St. Vincent's Hospital Melbourne. Department of Anaesthesia. ©2003