Essentials of intensive care medicine
Vascular access
Vascular access is a cornerstone of critical care, enabling the administration of fluids, medications, and hemodynamic monitoring in critically ill patients. Ensuring safe, effective, and timely vascular access is essential for optimizing patient outcomes, especially in emergencies or complex clinical scenarios.
This section explores central venous catheter (CVC) placement and intraosseous (IO) access, two key vascular access techniques used in intensive care:
- Ultrasound-guided CVC placement has become the standard of care, offering increased accuracy, reduced complications, and improved procedural success compared to traditional landmark techniques.
- Intraosseous access provides an alternative for rapid vascular access when intravenous (IV) cannulation is challenging, ensuring efficient delivery of fluids and medications in emergency situations.
By following evidence-based guidelines and best practices, healthcare professionals can enhance vascular access safety, efficiency, and overall patient care in critical settings.
Central venous catheter
Central venous catheter placement
Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice
Bernd Saugel et al., Critical Care (2017)
What’s inside
This review discusses the rationale, techniques, and evidence supporting ultrasound (US)-guided central venous catheter (CVC) placement, offering a structured approach for clinical practice.
Why it’s relevant
Traditional landmark techniques for CVC placement can be associated with complications due to anatomical variations and unseen venous thrombosis. US guidance enhances safety and success rates by allowing real-time visualization of vascular structures during catheter insertion.
Key focus
- Advantages of US guidance over landmark techniques in reducing complications during CVC placement.
- Basic principles of US-guided CVC placement, including equipment selection and imaging techniques.
- Evidence from clinical studies and existing guidelines supporting US use for CVC placement.
- A six-step systematic approach for US-guided central venous access in clinical practice.
Takeaway
Implementing US guidance for CVC placement improves patient safety and procedural success. Adopting a structured approach can standardize practice and enhance outcomes in critical care settings.
Intra-osseous access
Intra-osseous access
Use of intra-osseous access in adults: a systematic review
F Petitpas et al., Critical Care (2016)
What’s inside
This systematic review examines the use of intraosseous (IO) access in adults during emergency situations where peripheral intravenous (IV) access is challenging. It evaluates indications, contraindications, procedural techniques, and the efficacy of IO infusion for rapid administration of fluids and medications.
Why it’s relevant
In critical care settings, timely vascular access is crucial for resuscitation. IO access offers a viable alternative when traditional IV access is difficult, ensuring prompt delivery of life-saving interventions.
Key focus
- Indications for IO access, such as shock, cardiac arrest, and severe dehydration.
- Contraindications, including conditions like bone fractures or infections at the insertion site.
- Guidelines for IO catheter insertion, maintenance, and potential complications.
- Comparison of IO infusion with IV routes regarding medication bioavailability and patient outcomes.
Takeaway
IO access is an underutilized yet effective method for achieving rapid vascular access in adults during emergencies. Healthcare providers should be proficient in IO techniques to improve patient care when IV access is not feasible.