By Peter Papadakos
A pleasant extensive established great photo assessment of all proper themes in severe care. presentation is fresh and fresh. a great adjunct to The ICU e-book. you could crank out a bankruptcy in 20 min and feature it down sturdy.
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Additional info for Critical Care: A Volume in the Requisites in Anesthesiology Series
CENTRAL VENOUS CANNULATION Overview CVCs are essential for the management of critically ill patients. A large variety of catheters are available for venous access and the choice of catheter must be based on its intended purpose. CVCs are used for the infusion of vasoactive substances, intravascular volume replacement, total parenteral nutrition (TPN), hemodialysis, and hemodynamic monitoring. CVCs are routinely placed in many clinical settings; however, they are probably more frequent in operating rooms and ICUs.
When indicated, maintaining a safe distance, lead shielding, or dosimeter monitoring may be considered. When there is a possibility of pregnancy in either the patient or the provider, appropriate lead shielding is encouraged. Malposition of CVCs occurs in as many as 15% of cases, even when inserted by experienced clinicians. Therefore, a chest radiograph is indicated to check for catheter positioning as well as to rule out complications. Catheters placed via the internal jugular (IJ) approach are statistically less likely to be malpositioned than those placed by the subclavian route.
Patients with pre-existing left bundle branch block may develop complete heart block as the catheter tip passes through the right ventricular wall and stimulates the right bundle branch system. In these cases, the immediate availability of transcutaneous pacing should be considered. However, most catheterrelated arrhythmias are transient. A PAC may, under normal circumstances, migrate distally into smaller pulmonary artery segments with continued normal pulmonary blood flow. When the balloon tips of these catheters are subsequently inflated, there is initially a typical “over-wedging” waveform indicative of excessive balloon pressures.