4. Types of vascular access
• Venous access - most commonly performed .
»Cental
»Peripheral
• Arterial access
• Lymphatic access
• Intraosseous access
5. Indication of vascular access
Peripheral venous access:
• Fluid and drugs administration.
• Blood sampling
• Transfusion of blood and blood products
6. Indication of vascular access
Central Venous Access:
• Monitoring the CVP
• Dynamic fluid response
• Distinguishing cardiogenic shock from hypovolumic shock
• Assessment of rt. Ventricular function
• Total parenteral nutrition
• Infusion of drugs or chemotherapeutic agents
• Dialysis of renal failure patient
7. Indication of vascular access
Arterial Access:
• Arterial blood gas analysis
• Continuous blood gas analysis
• Continuous mean arterial pressure monitoring
• Arteriography & Angiography
9. Intraosseous access
• It provides access to a noncollapsible marrow venous plexus,
which serves as a rapid, safe, reliable route for administration of
drugs, crystalloids, colloids, and blood during resuscitation when
PIV access cannot be established rapidly in neonates & children.
10. Sites of Vascular Access
For Peripheral Venous Access-
• Dorsum of the hand and foot
• Forearm.
• Medial aspect of the ankle.
• The scalp.
11. Sites of Vascular Access
For Central Venous Access :
• Internal jugular vein - most commonly in right side.
• Subclavian vein
• Femoral vein
15. Sites of Vascular Access
For Peripheraly Inserted
Central Catheter –
• Basilic vein
• Cephalic vein
• Long saphenous vein
16. Sites of Vascular Access
Intraosseous Access:
• Proximal tibia- best site.
• Anteromedial flat surface of tibia 1-3 cm distal to the tibial
tuberosity.
• The distal tibia just above the medial malleolus
• Distal femur- 1-3 cm cephalad to the patella
17.
18. Color Size Flow
ml/min
Uses
Orange 14 275 Rapid transfusion of whole blood, emergency situation, large
volume replacement
Grey 16 173 Rapid transfusion of whole blood, high volume of fluids,
major surgery, Emergency situation
Green 18 100 Blood transfusion, Contrast study, delivery of irritant drugs,
Major surgery
Pink 20 60 IV fluids ,IV maintenance, IV analgesia, IV antibiotics
Blue 22 25 For children , Cytotoxic therapy
Yellow 24 13 Short term infusion , For neonate
19.
20. Complication of Vascular Access
Peripheral venous access
• Pain
• Failure to access the vein
• Blood stops flowing into the flashback chamber .
• Difficulty advancing the catheter over the needle and into the vein
• Difficulty flushing after the catheter was placed in a vein
• Arterial puncture
• Thrombophlebitis
21. Complication of Vascular Access
Central Venous Access
• Pneumothorax
• Haemothorax
• Air embolism
• Brachial plexus injury
• Carotid artery perforation
• Catheter tract infection
• Incorrect placement
29. Venesection
It is a surgical access of vein for infusion or transfusion in critically ill
patient.
Indication:
• Patient with Collapsed or thrombosed superficial vein due to shock or burn.
• When rapid infusion is needed through a wide bore cannula.
• The skilled & experienced person are not available for CVC.
• In patient with extensive soft tissue damage
35. INDICATION
• Angiography
• Venography
• Insertion of chest drains
• Insertion of Central venous catheters
• Insertion of PEG tubes using the push technique
• Insertion of the leads for an artificial pacemaker or
implantable cardioverter-defibrillator
36. PROCEDURE
• The desired vessel or cavity punctured with a sharp
hollow needle called a trocar
• A round-tipped guidewire is then advanced through
the lumen of the trocar, and the trocar is withdrawn.
• A "sheath" or blunt cannula is passed over the guidewire
into the cavity or vessel.
• After passing a sheath of tube, the guidewire is
withdrawn.
48. Take Home Message
• Although vacular system is a closed system of the body but
frequently need to access into the system for emergency &
elective situation for the patient .
• In performing any vascular access procedure, the performer must
be an expert in this regards.
