Gilchrist IC 201111


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Upper Extremity Venous Access and Procedure

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Gilchrist IC 201111

  1. 1. Upper Extremity Venous Access & Procedure Ian C Gilchrist, MD, FACC, FSCAI Professor of Medicine Heart & Vascular Institute Penn State/Hershey Medical Center Hershey, PA
  2. 2. CME Disclosure Statement Nothing
  3. 3. Arm Veins: Original Cardiac AccessWerner Forssmann Forssmann Klinische Wochenschrift 1929;8(45)2085-7.
  4. 4. Provide a Safe Approach to the Central Venous SystemAccess:Radial artery RIJ vein There is room for a safer way to the right heart & central venous systemComplication: Pneumothorax Icg/HMC cath lab
  5. 5. A New Playground beyond the arterial tree Right Heart Catheterization Transvenous Pacemakers Right Ventricular Biopsy Venous FiltersPotentially any technology with the right length
  6. 6. Venous System: Typical Patterns Radial (lateral)veins lead equally to either Cephalic or Basilic veins Ulnar (medial) veins usually continue as Basilic vein Chun et al. Radiology. 2003;226:918-920.
  7. 7. Upper Venous Junction Cephalic vein joins the Axillary vein at a T-Junction. – Defines start of the subclavian & central venous system – Location most likely to cause technical issues
  8. 8. Venous System Access Before entering the cath lab + + Nurse IV Catheter (20 g) Heparin Lock Nurse places heparin lock in forearm for use inthe catheterization lab for venous sheath access. • saves time • improves cath lab efficiency • fosters team building
  9. 9. Nurses unable to get access?Try in cath lab ± tourniquet °C Inspect arm carefully Ultrasound? Levophase angiogram?Don’t forget the other arm
  10. 10. Heparin Locks, Needles & WiresMicropuncture needle impaled in Heparin Lock (remove both in block off field for sterility) Wire holder Micropuncture needle Heparin lock on angiocath
  11. 11. 5F Right Heart Catheters (4 F also available) Edwards Lifescience TS105F5 Arrow Balloon Wedge AI-07124 105 cm 110 cmExamples from Penn State Hershey Medical Center Really need 125-cm , but industry not interested
  12. 12. Left/Right Heart Procedures Femoral vs Radial 250 Procedural Time Arterial Time 75±5.4 70±5.0 45±6.3 35±4.2 200 Time 150(minutes) Less radiation time p<.001 100 50 0 Femoral Radial Femoral Radial (n=175) (n=105) (n=175) (n=105) Gilchrist IC. Cathet Cardiovasc Intervent 2006;67:585-588.
  13. 13. Contraindications/Cautions Obstruction to drainage  Radial breast surgery  Trauma  SVC disease Prior brachial cutdown EP devicesRef (July 2006): http://assets.families. com/Encyclopedias/gea2_02_img0132.jpg No visible veins
  14. 14. SummaryFinish with hemostasis just like removing an IVIts simple & extends the potential of transradial Learning both arterial and venous techniques will make you a better cardiologist
  15. 15. Thank You you Thank