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Extracorporeal membrane oxygenation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Thomas Pranikoff, Ronald B. Hirschl
Ultrasound is used to evaluate the right internal jugular vein for patency and size. It is critical to be sure the vein is large enough to accommodate the cannula selected to prevent vein injury. The diameter in millimeters multiplied by three will yield the French size. The vein is accessed 2 cm superior to the clavicle under direct ultrasound visualization with a micropuncture needle (5 Fr micropuncture access kit, Cook Medical, Bloomington, IN). A flexible 0.45 mm (0.018 inch) × 40 cm (10 inch) guidewire with flexible tip is advanced into the right atrium using fluoroscopy. If guidewire placement is unsuccessful, conversion to a semi-open or open technique should be considered. A 5 Fr coaxial catheter/dilator is advanced over the guidewire and the inner cannula removed. This is then replaced with a 0.89 mm (0.035 inch) J-tip guidewire and either a 13 Fr or a 16 Fr Origen venovenous ECMO cannula (Origen Biomedical Inc., Austin, TX) is selected.
Neck Ultrasound
Published in John McCafferty, James M Forsyth, Point of Care Ultrasound Made Easy, 2020
Several important vascular structures travel through the neck, and ultrasound is an excellent way to evaluate these vessels. The main artery is the carotid, which divides into the internal and external carotid arteries mid-way up the neck at the approximate level of the thyroid cartilage. Lateral to the carotid arteries on both sides of the neck are the internal jugular veins. The smaller external jugular veins pass superficially over the sternocleidomastoid muscles and are of less clinical significance (see Figure 3.3).
Basic Ultrasound Use
Published in James Michael Forsyth, Ahmed Shalan, Andrew Thompson, Venous Access Made Easy, 2019
James Michael Forsyth, Ahmed Shalan, Andrew Thompson
If there are no suitable veins in either arm for cannulation, then the ultrasound can be used to scan the internal jugular veins in the neck (for consideration of central venous access). In this situation, ask the patient to turn his/her head to the opposite side to expose the sternocleidomastoid muscle running down from the mastoid process behind the ear towards the sternal head of the clavicular bone. This is where the internal jugular vein and carotid arteries are positioned (deep to the muscle). Place the probe over this part of the neck in transverse or longitudinal position and adjust the depth to optimise your view. Again, assess the suitability of the internal jugular vein by checking its compressibility (Figures 3.11 to 3.13).
Propofol/dexmedetomidine Versus Desflaurane Effects on Post Hepatectomy Hepatocellular Injury
Published in Egyptian Journal of Anaesthesia, 2023
Ola A. Saad Ali Lashin, Mohamed M. Abd- Elfattah Ghoneim, Hany M. Mohamed Elzahaby, Mohamed M. Mohamed Awad Rashed, Sahar M. Talaat Taha
After tracheal intubation, all patients of both groups were ventilated at 6–8 ml/kg tidal volume to keep end-tidal CO2 levels around 35 mmHg. A central venous line was placed in the internal jugular vein, and an invasive arterial line was placed in the radial artery. Patients were monitored for invasive blood pressure, blood oxygen saturation, ECG, end-tidal CO2, arterial blood gases, and urine output. In group A, anesthesia was maintained by infusing propofol at a rate of 0.1–0.2 mg/kg/min and dexmedetomidine infusion of maintenance dose at a rate of 0.6 mcg/kg/h. Ventilation was maintained by an oxygen-air gas mixture to achieve FiO2 0.5 and a flow of 2 L/min in a closed respiratory system. In group B, anesthesia was maintained by desflurane inhalation with vaporizer set between 4 and 10 vol% in FiO2 0.5 and a flow of 2 L/min in a closed respiratory system. Fentanyl was infused into both groups at a rate of 1–2 mcg/kg/h, and atracurium was infused at a rate of 0.3–0.6 mg/kg/h.
Goal-directed fluid therapy compared to liberal fluid therapy in patients subjected to colorectal surgery
Published in Egyptian Journal of Anaesthesia, 2023
Mona Gad Mostafa Elebieby, Mohamed Abdelkhalek, Zenat Eldadamony Mohamed Eldadamony, Mohammed Nashaat Mohammed
The patient’s medical background and physical condition were thoroughly evaluated. Basic demographic information such as age, gender, weight, and height were documented. A battery of diagnostic tests, including complete blood count, international normalized ratio, electrocardiogram, liver function tests, serum creatinine, serum lactate, arterial blood gases, and echocardiography (if deemed necessary), were conducted as part of the routine evaluation. Oxygen saturation, pulse rate, and arterial blood pressure were all measured. Fasting time would be noted. An appropriate intravenous line was placed where basal serum creatinine and lactate were obtained and recorded before surgery. Ultrasound-guided right internal jugular vein catheter was inserted. The application of electrodes from the ICON (ICONTM, OSYPKA medical cardiotonic, Elixir, Germany) was administered to all participants in both cohorts. Specifically, two of the electrodes were placed on the left aspect of the neck, and an additional two were placed on the thorax (left inferior side). Ringer’s acetate (500 ml) as a pre-induction infusion solution was initiated. Subsequently, a preoperative administration of 0.03 mg/kg midazolam was administered, followed by the collection of basal readings. Before induction catheter in the epidural space was inserted in all patients to facilitate postoperative analgesia.
Amidst COVID-19 pandemic: the catastrophic sequelae of an inadvertent carotid artery insertion during central venous catheter placement – a case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Mian Tanveer Ud Din, Adeel Nasrullah, Deeksha Sarma, Obaid Ashraf, Hammad Arshad
In the USA, physicians insert over 5 million CVCs annually, whereas around 200,000 CVCs are inserted in the National Health Service every year [3,4]. Indications for CVC include extracorporeal therapies like renal replacement therapy and plasmapheresis, hemodynamic monitoring, administration of peripherally incompatible infusions, and inadequate peripheral venous access. Unfortunately, CVC insertion, despite its benefit, is associated with multiple complications, some of which can result in catastrophic morbidity and mortality if not promptly and appropriately managed. Some of the more commonly recognized complications include arterial punctures, pneumothorax, subcutaneous hematoma, hemothorax, and cardiac arrest. According to current literature, arterial injuries have been reported in 3.7–12% of all central venous access procedures and 64% of arterial puncture injuries during CVC placement involved the carotid artery [5,6]. The internal jugular vein catheterization is more likely to be associated with arterial puncture resulting in catastrophic results [1]. The incidence of these complications is inversely related to the use of ultrasound (USG) and the operator’s experience [1].