Journal of clinical anesthesia
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Central venous catheterization plays an important role in patients with end-stage renal disease undergoing hemodialysis. Placement of a right subclavian hemodialysis catheter was complicated by looping and entrapment of the guidewire. Computed tomographic and three-dimensional scans were essential in locating and determining that the guidewire was outside the vessel.
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An effective hospital transfusion culture should encourage clinicians to consider the possibility of transfusion in their patients well before the need actually arises, and to plan ahead in an attempt to use blood products most efficiently. Strategies for improved blood utilization include timely and adequate preoperative assessment of risk, optimization of baseline hemoglobin, anticipation of potential transfusion problems, intraoperative techniques to minimize blood loss, blood conservation technologies, transfusion guidelines and targeted therapy, point of care testing, and massive transfusion protocols. Attention to these elements promotes a safe and cost-effective transfusion culture.