tailieunhanh - Báo cáo khoa học: "Clinical review: Alternative vascular access techniques for continuous hemofiltration"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: Alternative vascular access techniques for continuous hemofiltration. | Available online http content 10 5 230 Review Clinical review Alternative vascular access techniques for continuous hemofiltration Joseph V DiCarlo1 Scott R Auerbach2 and Steven R Alexander3 1 Division of Pediatric Critical Care Medicine Stanford University School of Medicine Welch Road Palo Alto California 94304 USA 2Department of Pediatrics Lucile Packard Children s Hospital Stanford University School of Medicine Welch Road Palo Alto California 94305 USA 3Division of Pediatric Nephrology Stanford University School of Medicine SUMC G306A Stanford California 94305 USA Corresponding author Joseph V DiCarlo jdicarlo@ Published 19 September 2006 This article is online at http content 10 5 230 2006 BioMed Central Ltd Critical Care 2006 10 230 doi cc5035 Abstract Obtaining or maintaining vascular access for continuous hemofiltration can sometimes be problematic especially in the child or adult in multiple organ failure with edema and or coagulopathy. Problems commonly encountered include obstruction of the femoral vein by the catheter insertion difficulties safety concerns when cannulating the subclavian vein in coagulopathy and catheter and circuit occlusion due to disseminated intravascular coagulation. For access in infants we describe a technique utilizing two single-lumen thin-walled vascular sheaths. For infants and small children initial access to the vein may be difficult due to edema or poor perfusion. For this situation we describe the miniintroducer technique of securing the vein and facilitating subsequent insertion of a relatively large guide wire. At any age an alternative route to the subclavian vein from above the clavicle is potentially compressible in the event of hemorrhage during the procedure. We remind the reader of the utility of ultrasound guidance for cannulation of the internal jugular and subclavian veins. And lastly we review the options for venous return via the umbilical vein in infants and via .