Vascular Access and Sheaths
Vikram S. Kashyap, Matthew Janko, Justin A. Smith in Endovascular Tools & Techniques Made Easy, 2020
In the most common technique (known as the modified Seldinger technique), the blood vessel is accessed with a hollow needle. After ensuring adequate position and blood return, a wire is thread into the vessel lumen, with care taken not to dissect the arterial walls (Figure 5.1). The original Seldinger technique was “modified” to avoid posterior wall penetration to prevent bleeding from the additional back wall through-and-through puncture (4). The course of the wire is confirmed using fluoroscopy, and subsequently a sheath or a catheter is advanced over the wire into the vessel. In our practice, we typically obtain access with a 21-gauge micropuncture kit and 0.018″ access wire, with subsequent escalation to a larger sheath. This minimizes needle trauma and provides the opportunity to abort with less consequences should the access site be unfavorable.
Preoperative assessment
Prem Puri in Newborn Surgery, 2017
Adequacy of the intravascular volume and the function of the heart can be assessed by a CVC, which can be inserted through the umbilical vein, internal jugular vein, subclavian vein, and femoral vein. Usually, catheters are placed using the Seldinger technique. This central line is often mandatory and a basic monitoring device for the anesthetist at the time of operation, and sometimes can be performed in the theatre immediately before starting the operation. It is a useful instrument for fluid resuscitation, administration of medication, and central venous pressure monitoring. The next step in the venous access hierarchy is the tunneled central line (commonly Hickman or Broviac). These are typically placed in either a neck or groin vein in neonates. PICC and tunneled central lines are relatively comparable in terms of efficacy and complications; however, if access is required for longer than 2 weeks, a tunneled central line is more suitable.52 However, CVC lines are not free from risks. Incidence of sepsis in neonates with central lines has been reported at 28%.53 Most catheter-related bloodstream infections respond to appropriate antibiotic treatment and/or catheter removal.54
Introduction
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
In contemporary practice, it is more common to use a modified Seldinger technique. In this technique, a sharp-ended needle (with a bevelled tip and no inner stylet) is advanced through the anterior wall of the artery until pulsatile flow of blood is seen coming out of the needle. A wire is then passed through the needle, with further steps as for the standard Seldinger technique to secure sheath access into the artery. The advantage of the modified Seldinger technique is that the posterior wall of the artery is not breached, resulting in less risk of bleeding from the posterior wall and subsequent haematoma formation. There is, however, an increased risk of subintimal passage of the guidewire, particularly if the bevel of the needle is partly within the arterial wall and partly within the lumen. The risk can be reduced by use of ultrasound to guide the puncture, especially in patients with a weak or absent pulse. Once arterial access has been secured with a sheath, appropriate guide wires and catheters can then be passed through it for diagnostic studies and interventions (Fig. 1.66c).
Assessment of complications and short-term outcomes of percutaneous peritoneal dialysis catheter insertion by conventional or modified Seldinger technique
Published in Renal Failure, 2021
Yun Zou, Yibo Ma, Wenying Chao, Hua Zhou, Yin Zong, Min Yang
The Seldinger technique is a blind penetration method with inherent complications, such as bowel perforation and bleeding. Bowel perforation is a serious early complication after PD catheter insertion with an incidence of about 1% [3]. Adhesion of the intestine to the abdominal wall, especially with repeated needle punctures could significantly increase the risk of bowel perforation and bleeding. The risk of adhesions in patients with previous abdominal surgery is reportedly as high as 70–90%, especially in patients with multiple prior laparotomies [20–22]. About 5% of patients even without a previous history of abdominal surgery can also have adhesions [23]. If there is relatively free movement of the small bowel by transabdominal ultrasound, the probability of significant adhesions is low, thereby reducing the risk of intraoperative bowel injury [24,25].
Deployment of acute mechanical circulatory support devices via the axillary artery
Published in Expert Review of Cardiovascular Therapy, 2019
Raj Tayal, Colin S. Hirst, Aakash Garg, Navin K. Kapur
Alternative arterial vascular access may be sought when traditional femoral arterial cannulation, either via an open surgical or percutaneous technique, is not feasible. Axillary arterial access can be gained through an open surgical approach, requiring a subclavicular incision parallel to the middle-third of the clavicle, dissection of the pectoralis major and minor muscles, transverse arteriotomy incision and subsequent placement of the arterial ECMO limb cannula. Axillary arterial cannulation can also be carried out through a surgical graft. A polytetrafluoroethylene (PTFE) or polyethylene terephthalate (Dacron) graft can be sewn to the axillary artery in an end-to-side fashion with a subsequent connection to the ECMO circuit [13,14]. Although surgical cannulation allows for direct arterial visualization, proper cannula sizing and verification of adequate hemostasis, this approach cannot be performed in an emergency situation. Alternatively, percutaneous axillary access can be obtained with ultrasound or Doppler ultrasonographic guidance via the Seldinger technique at the bedside or in the catheterization lab promptly.
The Safety and Efficacy of a Minimalist Approach for Percutaneous Transaxillary Transcatheter Aortic Valve Replacement (TAVR)
Published in Structural Heart, 2020
Yumiko Kanei, Waqas Qureshi, Nirmal Kaur, Jennifer Walker, Nikolaos Kakouros
Direct percutaneous transaxillary access was obtained with the arm abducted at 45º under direct ultrasound and fluoroscopic guidance with the use of a micropuncture system and modified Seldinger technique (Figure 1b,c). We aim to obtain access at the very distal end of the first part of the axillary artery, just proximal to the lateral thoracic artery, identified using ultrasound guidance. Depending on the anatomy, access just distal to this branch may also be obtained to allow sufficient distance between the access site and the subclavicular portion of the vessel, so as to facilitate open surgical repair if needed and manual compression of the proximal segment of the artery against the second rib. Two Perclose Proglide™ closure devices (Abbott Vascular, Abbott Park, IL, USA) were placed for preclosure, and an 8Fr sheath was inserted. Manual pressure proximal to the access site was applied during exchanges.
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