Midline Insertion
James Michael Forsyth, Ahmed Shalan, Andrew Thompson in Venous Access Made Easy, 2019
Procedure (ABCDEF) Asepsis. An aseptic technique and surgical scrub is required for all medium- to long-term venous access device insertions. This includes the use of a gown and sterile gloves – surgical ANTT. The upper medial aspect of the patient's arm will need to be cleaned with an appropriate antiseptic solution, and then sterile surgical drapes will have to be placed around the area of interest. The ultrasound probe will also need to be placed into a sterile ultrasound bag with ultrasound gel applied at its tip (Figures 8.3 to 8.5).Banding. A tourniquet should have been applied at moderate tightness around the upper arm at the axillary level.Catheter. Use the ultrasound to visualise the basilic vein. It is recommended to puncture at around the centre point of the upper medial arm. Infiltrate the local anaesthetic into the skin where you intend to cannulate the vein. Allow the anaesthetic to take effect (few seconds). Now insert the needle into the skin where you have injected the local anaesthetic. Puncture the vein along the same principles as described in Chapter 7 (i.e., leading the needle) (Figures 8.6 to 8.9).
Introduction
J. Terrence Jose Jerome in Clinical Examination of the Hand, 2022
The dorsum of the hand is convex with dorsal skin and nails, which are aesthetically important. It has less subcutaneous fat with more venous plexus up to the upper limb. Dorsal venous arches are seen in thin-built individuals. They are quite variable in arrangement and patterns. The basilic vein originates from the ulnar side of the hand and ascends to the upper limb.In contrast, the dorsal arch on the radial side forms the cephalic vein routinely used for intravenous cannulation. The dorsal skin is thin and allows free flexion and extension of the fingers and wrist. The knuckles are the metacarpophalangeal (MCP) joint and the metacarpal heads are prominent over the dorsum of the hand when making a fist.
Deltoid and Scapular Regions
Gene L. Colborn, David B. Lause in Musculoskeletal Anatomy, 2009
Identify the cephalic, basilic and median cubital veins and, observe their superficial and deep perforating tributaries (Fig. 5:3, 4). The basilic vein is comparable to the small (lesser) saphenous vein of the lower limb. That vein begins on the lateral aspect of the foot and ankle and passes upward to the soft hollow behind the knee, where the short saphenous vein drains into the popliteal vein.
Atrial fibrillation induced by peripherally inserted central catheters
Published in Baylor University Medical Center Proceedings, 2020
Reshma Golamari, Yub Raj Sedhai, Abubaker Jilani, Karthik Ramireddy, Priyanka Bhattacharya
A 45-year-old black man with hypertension diagnosed during the hospital stay was admitted for community-acquired pneumonia complicated by loculated empyema thoracis. He underwent video-assisted thoracoscopic surgery for drainage of empyema and thoracic decortication. This was complicated by respiratory failure requiring ventilator support. During the course of the hospitalization, the patient’s condition necessitated PICC placement. The port of entry was the right basilic vein, and the distal end terminated at the junction between the superior vena cava and right atrium, as confirmed by chest radiography. The PICC was stabilized at the port of entry by a StatLock stabilization device. The patient then developed new-onset rapid AF right after placement (Figure 1). His vital signs during the onset of AF were a heart rate of 147 beats/min and blood pressure of 137/71 mm Hg; he had 99% oxygen saturation on 60% fraction of inspired oxygen on the ventilator. His heart rate ranged in the 130s to 150s thereafter. Examination revealed normal breath sounds, irregular rhythm, and tachycardia. His laboratory parameters including thyroid-stimulating hormone levels were within normal limits.
Phenylephrine increases near-infrared spectroscopy determined muscle oxygenation during head-up tilt in men
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2018
Astrid H. Egesborg, Henrik Sørensen, Niels D. Olesen, Niels H. Secher
For evaluation of blood in the venous compartment, left basilic vein diameter was examined in longitudinal view by ultrasonography using a 12 MHz linear transducer (Logiq E, GE Medical System, Jiangsu, China) approximately 5 cm proximal to the medial epicondyle. The insonation site was marked and compression of the vessel avoided. Contrast and gain were adjusted to ensure the highest possible vessel wall echo while the lumen remained echo-free and adjustments were not changed during the protocol [22]. A video over 10 s was recorded at baseline before HUT, after 5 min of HUT, and 2 min after administration of phenylephrine. The vessel diameter was determined using automatic edge-detection wall tracking software (Brachial Analyser for Research v. 6, Medical Imaging Applications LLC, Coralville, IA, USA) and mean diameter reported.
Management of a patient with unintended intravenous dihydroergotamine infusion extravasation causing brachial artery vasospasm
Published in Baylor University Medical Center Proceedings, 2023
Jim Sheng, Callie Ebeling
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.
Related Knowledge Centers
- Axillary Vein
- Brachial Fascia
- Brachial Veins
- Fascia
- Superficial Vein
- Forearm
- Ulna
- Upper Limb
- Dorsal Venous Network of Hand
- Biceps