Venous access for either diagnostic or interventional
|
|
- Giles Stokes
- 5 years ago
- Views:
Transcription
1 Right Heart Catheterization Via the Radial Route Transradial access to the central venous system. BY IAN C. GILCHRIST, MD, FACC, FSCAI Venous access for either diagnostic or interventional procedures can be readily accomplished in a fashion complimentary to the techniques used for radial arterial access. Although peripheral access from the arm to the central venous system was reported in the first heart catheterization by Werner Forssmann in 1929, 1 it was generally forgotten as a technique until several recent reports from the transradial literature 2-4 resurrected its utility. Routine right heart catheterization has been supplanted in many cases by noninvasive technology; however, the need for access to the central venous system still exists in approximately 10% of cardiac catheterization laboratory procedures (Penn State Hershey Medical Center, unpublished data, February 2010). Understanding the basics of venous access from the forearm empowers the invasive operator to further expand the usefulness of transradial techniques and minimize the potential iatrogenic complications inherent in other similarly invasive techniques using nonradial access. This article is an overview of the technique to achieve central venous access from a forearm vein in the setting of transradial cardiac catheterization. It is meant to be a primer on the technique and focuses on how to get from skin entry to the central venous system. It is assumed that once central access is established, the operator will then be able to navigate the final path through the central venous and cardiac structures in a fashion consistent with standard catheterization techniques. ANATOMICAL CONSIDERATIONS The arm is a rich source of venous access. Although there is a general tendency for veins to accompany most arteries in the body, the region of interest during transradial procedures includes not only the area immediate to the radial Figure 1. Diagram of right forearm veins outlining the general location of each venous distribution. Adapted from Kimber DC, et al. Anatomy and Physiology for Nurses. 5th ed. New York, NY: Macmillan Company; MARCH/APRIL 2010 I CARDIAC INTERVENTIONS TODAY I 41
2 negotiated if using this lateral venous approach to the central system. Historically, the use of a cephalic approach was considered a relative contraindication for right heart access due to this sharply angled intersection and the potential for traumatic injury. Before introduction of soft balloon-tipped catheters in the late 1970s, typical right heart catheters were on the order of 8 F in size and were very stiff compared to present day equipment. Although both arteries and veins can dilate and increase in diameter, the capacity for venous enlargement significantly exceeds that of the arterial system. This compliance on the part of the venous system allows passage of equipment that, at first glance, may not seem possible based on arterial experience. Unfortunately, veins are not as resilient as arteries with respect to vessel wall strength, and overzealous forced dilation of these structures can result in rupture or tearing of their walls. Figure 2. Diagram of the right upper arm showing the T-junction of the cephalic/axillary junction marking the origin of the subclavian vein. Adapted from Kimber DC, et al. Anatomy and Physiology for Nurses. 5th ed. New York, NY: Macmillan Company; artery but essentially the entire forearm from the antecubital fossa down to the wrist. Figure 1 is a schematic of the forearm venous system. There is great variability among individuals in the actual course and number of these veins, but they are all potential sources of access to the central venous system. Functionally, veins that originate on the ulnar (medial) side of the forearm tend to drain in a relatively straight course into the basilic vein that then joins with the brachial vein to form the axillary vein and ultimately the subclavian vein (Figure 2). When advancing up by this approach, little fluoroscopic guidance may be required, and it may be possible to pass equipment to the pulmonary artery under only hemodynamic guidance. In addition, the veins in the upper forearm tend to be large (> 10 mm in diameter) and can tolerate larger-sized devices easily if needed. Veins that originate on the radial (lateral) side of the forearm tend to drain either into the cephalic or basilic vein with an even distribution. 6 The cephalic vein passes up laterally over the upper arm and enters the axillary vein at a junction referred to as a T-junction. This intersection can result in a right-angle turn that must be considered and FUNCTIONAL CONSIDERATIONS Early operators using stiff, large-bore equipment reported problems with spasm, including reports of resistant venospasm. This does not appear to represent a significant concern with present day, soft, small-caliber catheters. Nevertheless, veins have a muscular component that can contract and respond to vasoactive agents. The primary venodilating agent is nitroglycerin. Nitroglycerin can be delivered via many routes, including intravenously or topically over the course of the vein. Although routine use of vasodilators is recommended in the radial artery system, routine nitrates are not needed for venous catheterization. Likewise, both arteries and veins respond to nitrates; however, only arteries effectively respond to calcium-channel blockers, and therefore, calcium-channel blockers, such as verapamil or nicardipine, are not useful vasodilating agents in the venous system. Using hydrophilic sheaths that reduce arterial spasm may also provide some further protection against functional spasm when used in the venous system. In general, the risk of significant venospasm when using small-diameter equipment (5-F range) appears to be low and is rarely a clinical cause of procedural failure. TECHNIQUE The first step in venous access is deciding where access will be initially achieved and by whom. An efficient technique involves the nurse s first achieving venous access outside of the catheterization laboratory, with the procedure finished within the laboratory. In essence, initial venous access is achieved by the nursing staff or intravenous (IV) team and saves valuable catheterization laboratory time otherwise spent finding a vein. The vein is cannulated with a standard, peripheral IV catheter, and the access is capped 42 ICARDIAC INTERVENTIONS TODAYIMARCH/APRIL 2010
3 TABLE 1. COMPARISON OF 280 CONSECUTIVE PATIENTS UNDERGOING FEMORAL OR RADIAL BILATERAL HEART CATHETERIZATIONS Access Site P Value Femoral (n = 175) Radial (n = 105) Age ± 95% CI 64 ± 1.8 y 62 ± 2.8 y NS All Procedures Procedural time ± 95% CI 75 ± 5.4 min 70 ± 5 min P <.01 Arterial time a ± 95% CI 45 ± 6.4 min 35 ± 4.2 min P <.01 X-ray time ± 95% CI 15 ± 1.5 min 10.5 ± 1.2 min P <.001 Diagnostic Procedures Only n = 143 n = 98 Procedural time ± 95% CI 70 ± 4.1 min 70 ± 5 min NS Arterial Time a ± 95% CI 40 ± 5.1 min 35 ± 4.2 min P <.04 X-ray time ± 95% CI 12.6 ± 1.2 min 9.7 ± 1.1 min P <.001 Complications n = 12 n = 0 P <.001 Arteriovenous fistula 2 0 Pseudoaneurysm 4 0 Hematoma 6 0 Abbreviations: CI, confidence interval; NS, not significant. a Arterial time starts with arterial puncture and ends at the conclusion of the procedure in the cardiac catheterization laboratory. The femoral arterial sheath is removed later in the recovery area. Radial sheaths are removed at the end of arterial time while the patient is in the laboratory. Adapted from Gilchrist IC, et al. Transradial right and left heart catheterization: a comparison to traditional femoral approach. Cathet Cardiovasc Interv. (2006;67: ). 7 with a rubber or latex end that is typically referred to as a heparin lock in many hospitals. The antecubital fossa is the easiest target for large veins; however, there are advantages to using more peripheral veins along the forearm all the way out to the radial access site region. One advantage in using distal venous access involves the logic of moving away from the antecubital region because it has nerves and arteries in close proximity and is at increased risk for collateral damage if a complication occurs. Also, peripheral locations that are away from the joint lines provide easier and more comfortable anatomical locations for hemostasis. In general, if the equivalent of a 21-gauge IV catheter can be placed in a vein, it is usually adequate for subsequent placement of a 5-F micropuncture introducer and passage of a venous cardiac catheter. Although just about any vein can be used, the most common entry sites tend to be either just proximal to the wrist in a radial or ulnar vein or in the antecubital fossa when peripheral veins are sparse. Setup in the cardiac catheterization laboratory includes sterile preparation of the venous entry site, with care not to dislodge the heparin lock/venous catheter. Depending on its anatomical location, the skin preparation may be performed through the same opening required for radial artery access or through a separate location. If venous access has been achieved outside of the laboratory, there is no need for a tourniquet, and no laboratory time is wasted looking for veins. Before exchanging the heparin lock for a vascular sheath, the venous entry site should receive some subcutaneous anesthesia to prevent pain at the skin entry site. If the opera- MARCH/APRIL 2010 I CARDIAC INTERVENTIONS TODAY I 43
4 tor uses a surgical blade to nick the skin, care must be taken not to lacerate the superficial vein that may lie directly under the skin layer. After anesthesia, the access needle from a micropuncture access kit is pushed through the stopper at the end of the heparin lock, and the access kit s wire is then passed through the needle and up the IV catheter into the arm vein. The wire should be passed without resistance far enough to allow the exchange of the heparin lock system for the access sheath. When exchanging out the IV catheter equipment that was placed before entering the laboratory with the vascular sheath, the operator can handle the foreign catheter with a gauze and remove the needle, rubber stopper, and IV catheter together over the vascular wire without having physical contact with your gloves. This may further ensure the sterility of the field. For routine diagnostic right heart catheterization, there are commercially available 5-F balloon-tipped catheters and thermodilution catheters. Larger sheaths may be used depending on the vein location, size, and if venous access indicates that a larger introducer sheath is required. If larger sheaths are being used, it is important to consider whether the access is in the distribution that will drain medially up the arm and avoid the T-junction at the cephalic/axillary intersection, potentially impeding the passage of a large or stiff catheter. If venous access is not possible outside of the laboratory due to a lack of superficial veins, it may still be possible to find venous access. Many laboratories now have vascular ultrasound equipment for identifying vascular structures. By examining the deeper arteries, or even the radial and ulnar arteries, often a coexisting vein can be identified and its position can be localized relative to the artery. Palpating the artery and placing the needle at the estimated location of the deep vein will often provide venous access in patients in whom peripheral access was not initially deemed feasible. Once the vascular sheath is in place, it should be flushed with saline, but routine addition of a vasodilator is not needed. It is quite possible that attempts to withdraw fluid from the side arm will be unsuccessful because the vein easily collapses under the vacuum of drawback and may occlude the sheath. As long as the initial wire passed up the vein without resistance, the patient expressed no significant discomfort during sheath placement, and fluid flushes in the sheath easily, the sheath is most likely located in the venous system. Heparin or antithrombin therapy used for radial artery access should be administered as usual, although there are no data to support or deny the utility of anticoagulation for isolated venous puncture. Short-term venous catheterization with relatively small catheters has not been reported to produce acute thrombosis, so it is suspected that anticoagulation for isolate venous catheterization is probably not warranted. Long-term central venous Figure 3. Venogram of right cephalic vein taken through vascular sheath. A black arrow points to contrast leakage from the vein signifying a perforation near a sharp bend after a wire was pushed too hard. Procedure was completed using same vein without clinical complications. catheterization for monitoring from peripheral access has been associated with venous thrombus, and anticoagulation may be needed under those conditions. VENOUS ACCESS TO THE CENTRAL VENOUS SYSTEM With vascular venous access in place, the catheter to be used in the central venous system can then be advanced. The venous system should offer no resistance. Forceful advancement can cause vein perforation as demonstrated in Figure 3. Balloons used for flow direction should not be inflated until after they enter the subclavian vein or else forward movement may be impaired by balloon entrapment. Advancing up medially into the basilic and axillary vein is a very direct route to the central/subclavian system, and fluoroscopy is rarely needed except for troubleshooting. Entering the central venous system from the lateral aspect of the arm through the cephalic vein may require an evaluation at the level of the T-junction under fluoroscopy to ensure proper passage of the catheter toward the central system and not back down the axillary vein into the arm. Again, the balloon-tipped catheter should not be inflated until this T-junction is properly traversed. Deep breaths by the patient or use of a flexible wire placed through the lumen of the catheter may be needed to negotiate this junction. Force should never be applied to a catheter that is failing to transverse the T-junction or if it is held up along the way. Veins are more fragile than arteries and can tear or perforate if mishandled. Similar to techniques used to troubleshoot in the arterial system, a limited venogram can be very helpful 44 ICARDIAC INTERVENTIONS TODAYIMARCH/APRIL 2010
5 Figure 4. Venogram of right subclavian vein taken through right heart catheter located just distal to pacemaker leads. A black arrow points to area of chronic thrombosis that prevented catheter passage. Procedure was completed using a left arm vein without complications. in understanding why a catheter may not be progressing. A venogram may also demonstrate a variety of other channels that may be taken to the central system because the venous system is characterized by redundant interconnections, unlike the arterial tree, which has far fewer connections. Once the subclavian level is reached with the right heart catheter or device, manipulation is similar to any other access to the central system, be it from the subclavian or jugular veins. When the procedure is concluded, the catheter is withdrawn with its balloon deflated, and the vascular sheath can be removed from the venous system in the laboratory. Analogous to arterial access, venous access can be removed immediately, regardless of the anticoagulation status. Unlike in the arterial system, a firm hemostatic device is not needed, and the venous puncture site in the low-pressure venous system can be controlled for hemostasis with a simple compression bandage. CHALLENGES The most likely cause of difficulty in passing catheters from the peripheral veins of the forearm into the central system usually stems from trauma, either medically induced or from a previous accident resulting in venous occlusion. Occlusion of the proximal veins is usually asymptomatic, and clinical findings are usually absent. Obtaining a clinical history usually reveals the potential for difficulty and may prompt the operator to consider using the contralateral side or other sites of access. Previous trauma that resulted in humerus or shoulder fracture can produce collateral damage to the venous system that may prevent smooth passage to the central system. Damage induced by radiation therapy or central venous vascular ports for chemotherapy to treat malignancies can also sclerose veins so that they no longer easily allow catheters to pass. Finally, electrophysiology devices infrequently develop overlying organized thrombus that can also present a challenge in passing catheters. Figure 4 shows one example of pacemaker-associated venous thrombosis that prevented passage into the central venous system. If it is difficult to pass a catheter, a limited venogram, as mentioned previously, can be very instructive. The operator can determine if there is a solution for overcoming the challenge and easily entering the central system. Often, especially around pacing leads, a channel is seen, and efforts can then focus on passing through that particular region of the venous system. Likewise, the demonstration of only microvascular channels or bridging collaterals should probably result in a prompt re-evaluation for another site of venous access. CONCLUSION The need for central venous access, be it a right heart catheterization, temporary pacing wire, or even a larger device for a right ventricular biopsy, should not be an excuse to avoid the transradial arterial approach. The eloquence and safety of transradial cardiac interventions can be extended by becoming familiar with the techniques of central vein access from the arm. These procedures can be accomplished, as noted in Table 1, with results that are at least as good or better than similar procedures performed by more traditional approaches. 7 The addition of venous access to the basic transradial artery approaches can be useful in many situations, including anticoagulated patients, and adds further flexibility to the radialist s tool box. Ian C. Gilchrist, MD, FACC, FSCAI, is Professor of Medicine at Penn State s Heart and Vascular Institute, Hershey Medical Center in Hershey, Pennsylvania. He has disclosed that he holds no financial interest in any product or manufacturer mentioned herein. Dr. Gilchrist may be reached at (717) ; icg1@psu.edu. 1. Forssmann W. Die sondierung des rechten herzens. Klin Wochenschr. 1929;8: Gilchrist IC, Kharabsheh S, Nickolaus MJ, et al. Radial approach to right heart catheterization: early experience with a promising technique. Cathet Cardiovasc Interv. 2002;55: Cheng NJ, Ho WJ, Ko YS, et al. Percutaneous cardiac catheterization combining direct venipuncture of superficial forearm veins and transradial arterial approach: a feasibility approach. Acta Cardiol Sin. 2003;19: Lo TS, Buch AN, Hall IR, et al. Percutaneous left and right heart catheterization in fully anticoagulated patients utilizing the radial artery and forearm vein: a two-center experience. J Interv Cardiol. 2006;19: Kimber DC, Gray CE. Anatomy and Physiology for Nurses. 5th ed. New York, NY: Macmillan Company; Chun HJ, Byun JY, Yoo SS, et al. Tourniquet application to facilitate axillary venous access in percutaneous central venous catheterization. Radiology. 2003;226: Gilchrist IC, Moyer CD, Gascho JA. Transradial right and left heart catheterizations: a comparison to traditional femoral approach. Cathet Cardiovasc Interv. 2006;67: MARCH/APRIL 2010 I CARDIAC INTERVENTIONS TODAY I 45
Veins that are firm to
Intravenous cannulation is a technique in which a cannula is placed inside a vein to provide venous access. Venous access allows sampling of blood as well as administration of fluids, medications, parenteral
More informationCath Lab Essentials : Transradial Cardiac Catheterization
Cath Lab Essentials : Transradial Cardiac Catheterization Pranav M. Patel, MD, FACC, FSCAI Interim Chief, Division of Cardiology Director, Cardiac Catheterization Lab Associate Professor of Medicine University
More informationComplicaciones de Acceso Radial Cómo se Manejan?
Complicaciones de Acceso Radial Cómo se Manejan? Mauricio G. Cohen, MD, FACC, FSCAI Associate Professor of Medicine Director, Cardiac Catheterization Laboratory University of Miami Miller School of Medicine
More informationUpper Extremity Venous Duplex. Michigan Sonographers Society Fall Ultrasound Symposium October 15, 2016
Upper Extremity Venous Duplex Michigan Sonographers Society Fall Ultrasound Symposium October 15, 2016 Patricia A. (Tish) Poe, BA RVT FSVU Director of Quality Assurance Navix Diagnostix Patricia A. Poe
More informationDocument No. BMB/IFU/40 Rev No. & Date 00 & 15/11/2017 Issue No & Date 01 & 15/11/2017
Central Venous Catheter Device Description Multi-lumen catheters incorporate separate, non-communicating vascular access lumens within a single catheter body. Minipunctur Access Sets And Trays: Used for
More informationInterventional Cardiology
s Review Interventional Cardiology Right heart catheterization and other venous cardiovascular procedures from the arm Right heart catheterization using peripheral venous access is an approach initially
More informationDr. prakruthi Dept. of anaesthesiology, Rrmch, bangalore
CENTRAL VENOUS CATHETERIZATION Dr. prakruthi Dept. of anaesthesiology, Rrmch, bangalore OBJECTIVES Introduction Indications and Contraindications Complications Technique Basic principles Specifics by Site
More informationDirections For Use. All directions should be read before use
Directions For Use All directions should be read before use DEVICE DESCRIPTION: The CLEANER.XT Rotational Thrombectomy System is a percutaneous, 6Fr catheter based system (single piece construction) that
More informationAccess (Antegrade, Retrograde, Pedal)
Access (Antegrade, Retrograde, Pedal) ARCH St. Louis Craig M. Walker, MD, FACC, FACP Clinical Professor of Medicine Tulane University School of Medicine New Orleans, LA Clinical Professor of Medicine LSU
More informationRadial Basics. Samir B. Pancholy, MD, FACP, FACC, FSCAI. Program Director, Cardiology Fellowship, The Wright Center for Graduate Medical Center
Radial Basics Samir B. Pancholy, MD, FACP, FACC, FSCAI Program Director, Cardiology Fellowship, The Wright Center for Graduate Medical Center Associate Professor of Medicine, The Commonwealth Medical College,
More informationArterial Access for Diagnosis and Intervention T-Woei Tan, MD, FACS
Arterial Access for Diagnosis and Intervention T-Woei Tan, MD, FACS Assistant Professor of Surgery Vascular Endovascular Surgery Louisiana State University Health - Shreveport Disclosures None Objective
More informationParkland Health & Hospital System Women & Infant Specialty Health
Parkland Health & Hospital System Women & Infant Specialty Health NS 1700.04 Nursery Services Procedure Manual Arterial Puncture Practice Statement Upon the written order of the provider, the credentialled
More informationRECOMMENDED INSTRUCTIONS FOR USE
Rapid Exchange PTCA Dilatation Catheter RECOMMENDED INSTRUCTIONS FOR USE Available in diameters 1.25mm to 4.5mm and in lengths 09mm to 40mm Caution: This device should be used only by physicians trained
More informationKINGSTON GENERAL HOSPITAL NURSING POLICY AND PROCEDURE
KINGSTON GENERAL HOSPITAL NURSING POLICY AND PROCEDURE SUBJECT Sample (Adult): Advanced Competency (AC) for Nurses (Registered Nurses and Registered Practical Nurses) PAGE 1 of 5 ORIGINAL ISSUE 1985 January
More informationVascular Access: Management of Complications. Chris Burrell, South West Cardiothoracic Centre, Plymouth
Vascular Access: Management of Complications Chris Burrell, South West Cardiothoracic Centre, Plymouth Alternative Vascular Access Sites Femoral Axillary Brachial Radial Ulnar Femoral v Radial Vascular
More informationRadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved.
Interventional Radiology Coding Case Studies Prepared by Stacie L. Buck, RHIA, CCS-P, RCC, CIRCC, AAPC Fellow President & Senior Consultant Week of October 22, 2018 Paracentesis & Transjugular Liver Biopsy
More informationAs with any intervention, selection of an appropriate
DVT: ccess Decisions for Interventions ssessing the advantages and disadvantages of venous access options is crucial for safe and successful DVT intervention. Y JOHN. KUFMN, MD, MS, FSIR, FH, FCIRSE, EIR
More informationTransradial Complications How to predict/prevent and treat
Transradial Complications How to predict/prevent and treat David Kettles St Dominic s Private and Frere hospitals East London, South Africa Are all complications preventable? NO! Distal embolisation Vessel
More informationCase #1. Case #1- Possible codes. Unraveling the -59 modifier. Principles of Interventional. CASE 1: Simple angioplasty
Unraveling the -59 modifier Principles of Interventional Coding Donald Schon, MD, FACP Debra Lawson, CPC, PCS Distinct or independent from other services performed on the same day Normally not reported
More informationDEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service
M AY. 6. 2011 10:37 A M F D A - C D R H - O D E - P M O N O. 4147 P. 1 DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Food and Drug Administration 10903 New Hampshire Avenue Document Control
More informationPeel-Apart Percutaneous Introducer Kits for
Bard Access Systems Peel-Apart Percutaneous Introducer Kits for Table of Contents Contents Page Bard Implanted Ports Hickman*, Leonard*, Broviac*, Tenckhoff*, and Groshong* Catheters Introduction....................................
More informationCannulating LIMA Graft Using Right Transradial Approach: Two Simple and Innovative Techniques
Catheterization and Cardiovascular Interventions 80:316 320 (2012) Cannulating LIMA Graft Using Right Transradial Approach: Two Simple and Innovative Techniques Tejas Patel, 1,2 * MD, FACC, FSCAI, Sanjay
More informationA Primer on Central Venous Access: Peripherally-Inserted Central Catheters, Tunneled Catheters, and Subcutaneous Ports
Disclosures A Primer on Central Venous Access: Peripherally-Inserted Central Catheters, Tunneled Catheters, and Subcutaneous Ports No conflicts of interest relevant to this presentation Jason W. Pinchot,
More information1 Description. 2 Indications. 3 Warnings ASPIRATION CATHETER
Page 1 of 5 ASPIRATION CATHETER Carefully read all instructions prior to use, observe all warnings and precautions noted throughout these instructions. Failure to do so may result in complications. STERILE.
More informationOver the Wire Technique vs. Modified Seldinger Technique in Insertion of PICC
Over the Wire Technique vs. Modified Seldinger Technique in Insertion of PICC Deniz Kasikci Department of Radiology, Jena University Hospital Friedrich-Schiller-University, Jena, Germany Disclosure Speaker
More informationDirections For Use. All directions should be read before use. Page 1 of 8
Directions For Use All directions should be read before use Page 1 of 8 WARNING: For single use only. Do not reuse, reprocess or re-sterilize. Reuse, reprocessing or re-sterilization may compromise the
More informationYou have a what, inside you?
Costal Emergency Medicine Conference You have a what, inside you? Less than mainstream medical devices encountered in the ED. Eric Ossmann, MD, FACEP Associate Professor Duke University Medical Center
More informationCurtiss T. Stinis, M.D., F.A.C.C., F.S.C.A.I. SCRIPPS CLINIC
Avoiding and Managing Femoral Access Site Complications Curtiss T. Stinis, M.D., F.A.C.C., F.S.C.A.I. Director, Peripheral Interventions Program Director, Interventional Cardiology Fellowship Division
More informationUltrasound Guided Vascular Access. 7/25/2016
Ultrasound Guided Vascular Access 7/25/2016 www.ezono.com 1 Objectives Indications for insertion of central and peripheral lines Complications associated with procedures Role of ultrasound in vascular
More informationMary Lou Garey MSN EMT-P MedFlight of Ohio
Mary Lou Garey MSN EMT-P MedFlight of Ohio Function Prolonged and frequent access to venous circulation Allows for patient to carry on normal life; decrease number of needle sticks Medications, parenteral
More informationPer-Q-Cath* PICC Catheters with Excalibur Introducer* System
Bard Access Systems Per-Q-Cath* PICC and Catheters with Excalibur Introducer* System Instructions For Use Table of Contents Table of Contents Page Contents 1 Product Description, Indications & Contraindications
More informationMAXIMIZE RADIAL SOLUTIONS TO PERIPHERAL CHALLENGES
MAXIMIZE RADIAL SOLUTIONS TO PERIPHERAL CHALLENGES PUSHING BOUNDARIES Terumo Interventional Systems is committed to your success with innovative procedural solutions and ongoing support for your most challenging
More informationNON-COMPLIANT PTCA RAPID EXCHANGE DILATATION CATHETER
Page 1 of 5 NON-COMPLIANT PTCA RAPID EXCHANGE DILATATION CATHETER STERILE. SINGLE USE ONLY. Sterilized with ethylene oxide gas. Non pyrogenic. Do not resterilize. Do not use opened or damaged packages.
More informationVascular access device selection & placement. Alisa Seangleulur, MD Anesthesiology Department, Faculty of Medicine, Thammasat University
Vascular access device selection & placement Alisa Seangleulur, MD Anesthesiology Department, Faculty of Medicine, Thammasat University How to make the right choice of vascular access device.. Peripheral
More informationChapter 14: Arterial Puncture Procedures
Objectives Chapter 14: Arterial Puncture Procedures 1. Define the key terms and abbreviations listed at the beginning of this chapter. 2. State the primary reason for performing arterial punctures and
More informationER REBOA Catheter. Instructions for Use
ER REBOA Catheter Instructions for Use Prytime Medical Devices, Inc. 229 N. Main Street Boerne, TX 78006, USA feedback@prytimemedical.com www.prytimemedical.com US 1 210 340 0116 U.S. and Foreign Patents
More informationInstructions for Use Reprocessed LASSO Circular Mapping Diagnostic Electrophysiology (EP) Catheter
Instructions for Use Reprocessed LASSO Circular Mapping Diagnostic Electrophysiology (EP) Catheter Caution: Federal (USA) law restricts this device to sale by or on the order of a physician. DEVICE DESCRIPTION
More informationAcute dissections of the descending thoracic aorta (Debakey
Endovascular Treatment of Acute Descending Thoracic Aortic Dissections Nimesh D. Desai, MD, PhD, and Joseph E. Bavaria, MD Acute dissections of the descending thoracic aorta (Debakey type III or Stanford
More informationRadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved.
Interventional Radiology Coding Case Studies Prepared by Stacie L. Buck, RHIA, CCS-P, RCC, CIRCC, AAPC Fellow President & Senior Consultant Week of October 29, 2018 Mesenteric Arteriogram & Thrombectomy/Thrombolysis
More informationThe SplitWire Percutaneous Transluminal Angioplasty Scoring Device. Instructions for Use
The SplitWire Percutaneous Transluminal Angioplasty Scoring Device Instructions for Use Contents Contains one (1) SplitWire device. Sterile. Sterilized with ethylene oxide gas. Radiopaque. For single use
More informationYou have a what, inside you?
Costal Emergency Medicine Conference You have a what, inside you? Less than mainstream medical devices encountered in the ED. Eric Ossmann, MD, FACEP Associate Professor Duke University Medical Center
More informationIntroduction to the Native Arteriovenous Fistula: A primer for medical students and radiology residents
Introduction to the Native Arteriovenous Fistula: A primer for medical students and radiology residents Jesus Contreras, D.O. PGY-4 John Yasmer, D.O. Department of Radiology No Disclosures Objectives Introduce
More informationRADIAL ACCESS in endovascular surgery. A Cardon, A Kaladji, E Clochard CHU RENNES
RADIAL ACCESS in endovascular surgery A Cardon, A Kaladji, E Clochard CHU RENNES why radial access CI of femoral Access Less entry site complications : 0.3% vs 2.8% Association kardegic plavix Ambulatory
More informationEffective Date: Approved by: Laboratory Executive Director, Ed Hughes (electronic signature)
1 Policy #: 407 (PLH-407-02) Effective Date: NA Reviewed Date: 2/1/2008 Subject: ARTERIAL PUNCTURE PROCEDURE Approved by: Laboratory Executive Director, Ed Hughes (electronic signature) Approved by: Laboratory
More informationAdvocate Christ Medical Center CVC Placement Certification Course
Advocate Christ Medical Center CVC Placement Certification Course July 12th, 2012 Hannah Watts, MD Medical Simulation Director Modified August 10, 2017 Taajwar Khan, MD Chief Resident of Internal Medicine
More informationVenepuncture and Cannulation. Louise Smith Clinical Nurse Specialist
Venepuncture and Cannulation Louise Smith Clinical Nurse Specialist Outcomes By the end of this session you will be aware of: Basic anatomy Preparation procedures including patient identification Equipment
More informationCRT Implantation Techniques 부천세종병원순환기내과박상원
Cardiac Venous System and CRT Implantation Techniques 부천세종병원순환기내과박상원 Cardiac Resynchronization Therapy (CRT) Goal: Atrial synchronous biventricular pacing Transvenous approach for left ventricular lead
More informationSurgical Options in Thrombectomy for Non-Surgeons
Surgical Options in Thrombectomy for Non-Surgeons Shouwen Wang, MD, PhD, FASDIN AKDHC Ambulatory Surgery Center Arizona Kidney Disease and Hypertension Center Phoenix, Arizona Disclosure No relevant financial
More informationCoronary angiography and PCI
Coronary arteries Coronary angiography and PCI Samo Granda, Franjo Naji Department of Cardiology Clinical department of internal medicine University clinical centre Maribor Coronary arteries Atherosclerosis
More informationTranscatheter Aortic Valve Implantation Procedure (TAVI)
Page 1 of 5 Procedure (TAVI) Introduction Aortic stenosis (AS) is a common heart valve problem associated with heart failure and death. Surgical valve repair or replacement is recommended if AS patients
More informationInterventional Treatment for Complete Occlusion of Arteriovenous Shunt: Our Experience in 39 cases
Chin J Radiol 2003; 28: 137-142 137 Interventional Treatment for Complete Occlusion of Arteriovenous Shunt: Our Experience in 39 cases SHE-MENG CHENG SUK-PING NG FEI-SHIH YANG SHIN-LIN SHIH Department
More informationTitle: EZ-IO. Effective Date: January SOG Number: EMS Rescinds:
S O G Title: EZ-IO Effective Date: January 2010 SOG Number: EMS - 25 Rescinds: Scope: Providers Authorized are AIC s in the following certifications EMT-I and EMT-P who have been trained and cleared by
More informationCatheters and Wires. Dr. Vaibhav Jain MD,DNB,MNAMS Senior Consultant, IR Medanta, the Medicity, Gurgaon
Catheters and Wires Dr. Vaibhav Jain MD,DNB,MNAMS Senior Consultant, IR Medanta, the Medicity, Gurgaon Guidewires: Guidewires (solid wires navigated within the vascular system / extravascular tract) act
More informationAngioplasty remains the most common method
When AVF Angioplasty Fails Defining procedural success and overcoming common problems. By Thomas M. Vesely, MD Angioplasty remains the most common method of treating obstructive vascular stenoses associated
More informationBackground & Indications Probe Selection
Teresa S. Wu, MD, FACEP Director, EM Ultrasound Program & Fellowship Co-Director, Simulation Based Training Program & Fellowship Associate Program Director, EM Residency Program Maricopa Medical Center
More informationCAREFULLY READ ALL INSTRUCTIONS PRIOR TO USE
CAREFULLY READ ALL INSTRUCTIONS PRIOR TO USE INDICATIONS FOR USE The LATERA Absorbable Nasal Implant is indicated for supporting upper and lower lateral nasal cartilage. CAUTION: Federal law restricts
More informationVascu-PICC WITH CUFF PERIPHERALLY INSERTED CENTRAL VEIN ACCESS CATHETER INSTRUCTIONS FOR USE
Vascu-PICC WITH CUFF PERIPHERALLY INSERTED CENTRAL VEIN ACCESS CATHETER INSTRUCTIONS FOR USE INDICATIONS FOR USE: The Vascu-PICC with cuff Peripherally Inserted Central Vein Catheters are designed for
More information(EU), FACC (USA), FSCAI (USA)
How to reduce vascular complications of TAVI Paul TL Chiam MBBS (S pore), MMed, MRCP (UK), FAMS FRCP (Edin), FESC (EU), FACC (USA), FSCAI (USA) Cardiologist Mount Elizabeth Hospital Singapore Definition
More informationFor exam: VL DUPLEX EXTREMITY VEINS UNILAT LT
For exam: VL DUPLEX EXTREMITY VEINS UNILAT LT - 8870390 METHOD/TECHNIQUE: The veins of the left upper extremity were studied at multiple For exam: VL DUPLEX EXTREMITY VEINS UNILAT RT - 8870400 METHOD/TECHNIQUE:
More informationRecanalization Techniques: Sharp Needle Recanalization. Recanalization Techniques: Sharp Needle Recanalization
Recanalization of Occluded Central Veins When Conventional Methods Failed: Abigail Falk, MD, FSIR American Access Care New York, NY Conventional Methods of Recanalization Directional 0.035 and 0.018 Guidewires
More informationVENOUS DRAINAGE O US F UPPER UPPER LIM B BY dr.fahad Ullah
VENOUS DRAINAGE OF UPPER LIMB BY dr.fahad Ullah Venous drainage of the supper limb The venous system of the upper limb drains deoxygenated blood from the arm, forearm and hand It can anatomically be divided
More informationThruPort systems ProPlege peripheral retrograde cardioplegia device
ThruPort systems ProPlege peripheral retrograde cardioplegia device Training Module Lessons Lesson 1: ProPlege device Lesson 2: Preparing for the case Lesson 3: Utilizing the device Lesson 4: Troubleshooting
More information2. Need for serial arterial blood gas determinations. 2. Anticipation of the initiation of thrombolytic therapy
I. Subject: Arterial Cannulation II. Policy: Arterial cannulation will be performed upon a physician's order by Cardiopulmonary and Respiratory Therapy personnel certified in the arterial catheterization
More informationCordis EXOSEAL Vascular Closure Device
to receive our latest news and key activities. Cordis EXOSEAL Vascular Closure Device A Guide to Good Access and Closure Transfemoral Access Closure Pocket Guide LinkedIn page Follow us on CORDIS EMEA
More informationCentral Venous Line Insertion
Central Venous Line Insertion Understand the indications and risks of CVC insertion Understand and troubleshoot the seldinger technique Understand available sites and select the appropriate site for clinical
More informationUltrasound Guidance during Arterial Access for Peripheral Vascular Intervention: A VSGNE Quality Improvement Project
Ultrasound Guidance during Arterial Access for Peripheral Vascular Intervention: A VSGNE Quality Improvement Project Jeffrey Kalish, David Gillespie, Marc Schermerhorn, Daniel Bertges, Chris Healey, Paul
More informationCertificate in Clinician Performed Ultrasound (CCPU) Syllabus. Vascular Access (venous (peripheral and central) and arterial)
Certificate in Clinician Performed Ultrasound (CCPU) Syllabus Vascular Access (venous (peripheral and central) and arterial) Page 1 of 8 04/16 Vascular Access (venous (peripheral and central) and arterial)
More informationUltrasound Guidance Needle Techniques
Ultrasound Guidance Needle Techniques Dr TANG Ho-ming AED/UCH USG Guidance Needle Techniques Commonly used in EM 1. Vessel cannulation-peripheral & central 2. Foreign body removal 3. Peripheral nerve/plexus
More informationCLARIVEIN INFUSION CATHETER
CLARIVEIN INFUSION CATHETER General Product Description Overview The ClariVein Infusion Catheter (ClariVein -IC) is an infusion catheter system designed to introduce physician-specified medicaments into
More informationCatheter Fracture of a Totally Implantable Venous Device Due to Pinch Off Syndrome in Breast Cancer: A Case Report
Kosin Medical Journal 2016;31:167-172. https://doi.org/10.7180/kmj.2016.31.2.167 KMJ Case Report Catheter Fracture of a Totally Implantable Venous Device Due to Pinch Off Syndrome in Breast Cancer: A Case
More informationThe CardioMEMS HF system (Abbott Vascular,
How to Implant the CardioMEMS Heart Failure Sensor A step-by-step review of the sensor implantation procedure, including pre- and postprocedural assessment. BY DAVID M. SHAVELLE, MD, FACC, FSCAI The CardioMEMS
More informationArterial Line Insertion Pre Reading
PROCEDURE ACCREDITATION THE CANBERRA HOSPITAL EMERGENCY DEPARTMENT Arterial Line Insertion Pre Reading Indications Requirement for continuous blood pressure monitoring (all patients on pressors, inotropes,
More informationCase Report Hemostasis of Left Atrial Appendage Bleed With Lariat Device
273 Case Report Hemostasis of Left Atrial Appendage Bleed With Lariat Device Amena Hussain MD, Muhamed Saric MD, Scott Bernstein MD, Douglas Holmes MD, Larry Chinitz MD NYU Langone Medical Center, United
More informationVaxcel Implantable Ports Valved and Non-Valved. A Patient s Guide
Vaxcel Implantable Ports Valved and Non-Valved A Patient s Guide Vaxcel Implantable Port This pamphlet provides some answers to questions you may have about your implantable port and how to care for it
More informationVictoria Chapman BS, RN, HP (ASCP)
Victoria Chapman BS, RN, HP (ASCP) Considerations: Age Sex Body Composition Hydration Status Chemotherapy Use Access History Considerations: Immunosuppression Use Chemotherapy Frequency of plasma exchanges
More informationRadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved.
Interventional Radiology Coding Case Studies Prepared by Stacie L. Buck, RHIA, CCS-P, RCC, CIRCC, AAPC Fellow President & Senior Consultant Week of June 4, 2018 Thrombolysis, Thrombectomy & Angioplasty
More informationLutonix AV Clinical Trial
Lutonix AV Clinical Trial Long Term Effects of LUTONIX 035 DCB Catheter 18 month Interim Results Scott O. Trerotola, MD Stanley Baum Professor of Radiology Professor of Surgery Associate Chair and Chief,
More informationPatient guide: pfm Nit-Occlud PDA coil occlusion system. Catheter occlusion of. Patent Ductus Arteriosus. with the
Patient guide: Catheter occlusion of Patent Ductus Arteriosus with the pfm Nit-Occlud PDA coil occlusion system pfm Produkte für die Medizin - AG Wankelstr. 60 D - 50996 Cologne Phone: +49 (0) 2236 96
More informationQuick Reference Guide
Quick Reference Guide Indications for Use The AFX Endovascular AAA System is indicated for endovascular treatment in patients with AAA. The devices are indicated for patients with suitable aneurysm morphology
More informationNit-Occlud. Coil System for PDA Closure IMPLANTATION POCKET GUIDE. Rx only CV / B. Braun Interventional Systems Inc.
Refer to the Nit-Occlud PDA Instructions for Use for relevant warnings, precautions, complications and contraindications. This device has been designed for single use only. Nit-Occlud Coil System for PDA
More informationAdvancing Lives and the Delivery of Health Care. The High-Flow Port Designed for Apheresis
Advancing Lives and the Delivery of Health Care The High-Flow Port Designed for Apheresis Optimized for Long Device Life Bench Tested up to 1,000 Accesses 1 Bard is proud to introduce the first and only
More informationMODULE 9 ARTERIAL AND VENOUS CATHETERIZATION. Robert B. McLafferty M.D. Southern Illinois University
MODULE 9 ARTERIAL AND VENOUS CATHETERIZATION Robert B. McLafferty M.D. Southern Illinois University I. OBJECTIVES By the end of this laboratory session the residents should be able to A. Identify the anatomic
More informationAll bedside percutaneously placed tracheostomies
Page 1 of 5 Scope: All bedside percutaneously placed tracheostomies Population: All ICU personnel Outcomes: To standardize and outline the steps necessary to safely perform a percutaneous tracheostomy
More informationIntro: Slide 1. Slide 2. Slide 3. Basic understanding of interventional radiology. Gain knowledge of key terms and phrases
Slide 1 Intro: PRESENTED BY: Selena M. Moore, AAS, CCS, CPC HIMS Physician Liaison Coder This is a modified/updated presentation that was originally written by: Rosemary Waligorski, RHIT, CCS, RCC and
More informationBalloon in Balloon (BIB )
in (BIB ) Dilatation Catheter INSTRUCTIONS FOR USE CAUTION: FEDERAL (USA) LAW RESTRICTS THIS DEVICE TO SALE BY OR ON THE ORDER OF A PHYSICIAN. Read all instructions prior to use. Distributed by: B. Braun
More informationCentral Line Care and Management
Central Line Care and Management What is a Central Line/ CVAD? (central venous access device) A vascular infusion device that terminates at or close to the heart or in one of the great vessels (aorta,
More informationUpper Extremity Venous Duplex Evaluation
VASCULARTECHNOLOGY PROFESSIONAL PERFORMANCE GUIDELINES Upper Extremity Venous Duplex Evaluation This Guideline was prepared by the Professional Guidelines Subcommittee of the Society for Vascular Ultrasound
More informationFigure 1: Revolution TM Peripheral Atherectomy System Diagram. Table 1: Revolution TM Peripheral Atherectomy System Specifications Minimum Burr
Instructions For Use All instructions should be read before use CAUTION Investigational Device. Limited by Federal (or United States) law to investigational use. DEVICE DESCRIPTION: The Revolution TM Peripheral
More informationDisclosures. Tips and Tricks for Tibial Intervention. Tibial intervention overview
Tips and Tricks for Tibial Intervention Donald L. Jacobs, MD C Rollins Hanlon Endowed Professor and Chair Chair of Surgery Saint Louis University SSM-STL Saint Louis University Hospital Disclosures Abbott
More informationClinical Study Study of the Influence of Upper Extremities Variation on Transradial Success
Angiology Volume 2013, Article ID 150743, 6 pages http://dx.doi.org/10.1155/2013/150743 Clinical Study Study of the Influence of Upper Extremities Variation on Transradial Success Saeed Yazdankhah, Ahmadreza
More informationGuidelines, Policies and Statements D20 Statement on Peripheral Venous Ultrasound
Guidelines, Policies and Statements D20 Statement on Peripheral Venous Ultrasound Disclaimer and Copyright The ASUM Standards of Practice Board have made every effort to ensure that this Guideline/Policy/Statement
More informationZiyad M. Hijazi, M.D., MPH, FSCAI, FACC
Ziyad M. Hijazi, M.D., MPH, FSCAI, FACC Professor of Pediatrics & Internal Medicine Rush University Medical Center Chicago Traditional Venous & arterial Access! 1. Umbilical vein/artery 2. Femoral Veins/arteries
More informationChildren's (Pediatric) PICC Line Placement
Scan for mobile link. Children's (Pediatric) PICC Line Placement A peripherally inserted central catheter (PICC line) is most often used to deliver medication over a long period. The doctor or nurse inserts
More informationSample page. POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit optum360coding.com.
2018 Complete Guide for Interventional Radiology An in-depth guide to interventional radiology coding, billing, and reimbursement for facilities and physicians POWER UP YOUR CODING with Optum360, your
More informationGirish M Nair, Seeger Shen, Pablo B Nery, Calum J Redpath, David H Birnie
268 Case Report Cardiac Resynchronization Therapy in a Patient with Persistent Left Superior Vena Cava Draining into the Coronary Sinus and Absent Innominate Vein: A Case Report and Review of Literature
More informationTHE VESSELS OF BLOOD CIRCULATION
THE VESSELS OF BLOOD CIRCULATION scientistcindy.com /the-vessels-of-blood-circulation.html NOTE: You should familiarize yourself with the anatomy of the heart and have a good understanding of the flow
More informationFLEXIC ATH LTD. Peripherally Inserted. Instructions n For Use.
FLEXIC ATH LTD * M/29M Peripherally Inserted Catheter Instructions n For Use This leaflet contains instructions for both stan- dard needle-introducer er and protection con- tained M/29 models, i.e., with
More informationEvaluation of AVF and AVG
Evaluation of AVF and AVG 2013 Nephrology Nursing Symposium Albuquerque Vascular Access Leading cause of hospitalization in the ESRD population Annual cost approaching $1.5 billion (USRDS, 2004) Current
More informationAppendix E: Overview of Vascular
Appendix E: Overview of Vascular 56 Peripheral Short Catheter, less than 3 inches (7.5 cm) in length; over-the-needle catheter is most common. Inserted by percutaneous venipuncture, generally into a hand
More information