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Transplant Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
David van Dellen, Zia Moinuddin, Hussein Khambalia, Brian KP Goh
The vein mapping shows good-quality signals in the radial, brachial and ulnar arteries bilaterally. The cephalic vein is 1.9 mm at the wrist and forearm and 3.2 mm at the elbow bilaterally. The basilic vein is 2.4 mm at the elbow and arm.
Arteriovenous Fistulas for Chemotherapy
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
When chemotherapy has been previously given indiscriminately it may be difficult to find patent veins at dissection. If the cephalic vein has thick walls, with poor blood flow, this vessel cannot be used because of a high risk of thrombosis. Usually the basilic vein cannot be used for the same reason. Two solutions can be used in this case.
Single Best Answer Assessment
Published in James Michael Forsyth, Ahmed Shalan, Andrew Thompson, Venous Access Made Easy, 2019
James Michael Forsyth, Ahmed Shalan, Andrew Thompson
A 65-year-old female is on the orthopaedic ward following a washout of a left knee septic arthritis. She requires long-term intravenous antibiotics. She has previously had a nasty left clavicle fracture which was managed conservatively. Her left arm is more swollen than the right and she has prominent venous dilatation around her left upper chest wall and axillary region. On review of a chest x-ray performed a few months ago, you can see that the left clavicle has healed in a very deformed position. Ultrasound assessment reveals a healthy basilic vein on the right side. On the left side, the basilic vein appears much larger than the right and is slightly more difficult to compress. Her internal jugular veins appear normal.
Contemporary review of management techniques for cephalic arch stenosis in hemodialysis
Published in Renal Failure, 2023
Gift Echefu, Shivangi Shivangi, Ramanath Dukkipati, Jon Schellack, Damodar Kumbala
The Cephalic vein is part of the upper extremity’s superficial venous system. It originates in the anatomical snuffbox from the radial aspect of the superficial venous network of the dorsum of the hand. Coursing along the anterolateral forearm to the elbow, it communicates with the basilic veins via median ante-cubital veins. It then courses along the lateral aspect of the biceps toward the pectoralis major muscle as it enters the deltopectoral groove (a triangular space formed by the adjacent borders of the deltoid and pectoralis major muscles Figure 2). It then passes under the clavicle, turning sharply to pierce the clavipectoral fascia terminating as the axillary vein. The cephalic arch refers to the final arch of the cephalic vein before it drains into the first part of the axillary vein.
Management of a patient with unintended intravenous dihydroergotamine infusion extravasation causing brachial artery vasospasm
Published in Baylor University Medical Center Proceedings, 2023
A 40-year-old woman with a past medical history of chronic migraines was admitted for refractory status migrainosus and treated with once-daily DHE infusion for 3 days. At our institution, intravenous DHE treatments are prepared with 1 mg of DHE constituted in either 100 mL of normal saline or D5W and infused over 20 minutes. On admission, a midline (14 cm, 4 French single lumen) catheter was inserted into the patient’s right basilic vein. During her third treatment dose, the catheter infiltrated with extravasation of DHE into the adjacent soft tissue. The catheter was promptly removed without issue. The patient then reported significant sharp, stabbing pain from the midline insertion site radiating to the ulnar aspect of the right hand, associated with paresthesia and numbness of the same region. There were no reported color changes in the extremity (Figure 1). The right radial pulse remained palpable but diminished. The right ulnar pulse was difficult to palpate but evident on Doppler. Formal Doppler ultrasound of the arm revealed arterial wall thickening and moderate/severe stenosis in the proximal right brachial artery. Computed tomography angiogram showed poor contrast opacification of the distal circulation. The patient was initially managed conservatively with nitroglycerin ointment (or nitropaste) and heating pads without improvement.
Bone morphogenetic protein-9 maybe an important factor which improves insulin resistance in PCOS
Published in Gynecological Endocrinology, 2022
Xiaoying Yuan, Qi Huang, Jing Li, Qu Yao, Han Zhang, Qian Wang, Lin Zhang, Ying Zhang, Gangyi Yang, Ling Li, Xin Liao
Subjects underwent the EHC test at 8 am after 12 h of fasting. After urinating, the patients lied flat on the bed for half an hour, and a catheter was placed in one arm for the subsequent procurement of arterialized venous blood specimens. Intravenous indwelling needles were placed in the median basilic veins of both elbows. One side of the thermostat was used to collect the blood samples in saline, and the other side was used to infuse 20% glucose solution and insulin. The insulin infusion rate was maintained at 1 mU/kg/min, arterial venous blood glucose (BIOSEN C-line Lactic Acid Analyzer, EKF Diagnostics, Germany) was measured in the blood sampling channel every 5 min, and the 20% glucose infusion rate (GIR) was adjusted as necessary. The blood glucose level was controlled at approximately 5.0 mmol/l for 120 min. The value at 80-120 min after the start of the EHC test was considered the steady-state value, the GIR was calculated, and the glucose metabolism rate (M value) in peripheral tissue was obtained to evaluate insulin sensitivity, i.e. the degree of IR (M value < 6.286 mg/kg/min).