The journal of vascular access
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Case Reports
Ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for vascular access surgery.
We report the use of a newly described regional technique, ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for surgical anesthesia in two high-risk patients undergoing 2nd stage transposition of basilic vein fistula. ⋯ Ultrasound-guided costoclavicular approach can be an alternative way of providing effective analgesia and safe anesthesia for vascular access surgery of the upper limb.
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Comparative Study
Bursting pressure of triple-lumen central venous catheters under static and dynamic loads.
Central venous catheter (CVC) access is commonplace in intensive care units. Patients undergoing computed tomographic angiography require injection of contrast at high flow rates (4.5 mL/s), often CVC access is not used due to safety concerns. The CVC might rupture at high flow rates, resulting in CVC fragmentation and embolization or contrast extravasation.The objective of this study is to determine the pressure required to burst a CVC under static load and compare this to the pressure generated by injection of contrast at high flow rates (dynamic load) through the distal (16-g) lumen of a triple-lumen CVC. ⋯ No CVCs failed under dynamic loading with injection of contrast at flow rates (4.5 and 7 mL/s) high enough to support computed tomographic angiography. This suggests 16-cm triple-lumen CVCs can be used safely.
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The coexistence of a double superior vena cava (SVC) and a partially left inferior vena cava (PLIVC) with a circumaortic collar, associated with other congenital malformations, was not described previously. ⋯ The double SVC was related to the persistence of the caudal part of the anterior cardinal veins. As to the PLIVC, the iliac and subrenal parts of the inferior vena cava can be related to the persistent left supracardinal vein, while the circumaortic venous collar to the persistent intersupracardinal and left subsupracardinal anastomoses. All invasive procedures, and particularly those potentially complicated, must be performed under EST, now considered a mandatory tool for CVC implants, owing to the hypothesis of possible venous congenital anomalies.