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4 - Establishing Vascular Access in the Trauma Patient

Published online by Cambridge University Press:  18 January 2010

By
Matthew A. Joy ,
Donn Marciniak  and
Kasia Petelenz-Rubin
Edited by
Charles E. Smith
Matthew A. Joy
Affiliation:
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Donn Marciniak
Affiliation:
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Kasia Petelenz-Rubin
Affiliation:
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
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Summary

Objectives

  1. Describe in a structured approach the advantages and disadvantages of various types of intravascular access and infusion devices in the trauma patient.

  2. Present practical guidelines for the establishment of central venous access in the critically injured patient.

  3. Describe in detail the technique for insertion of various central access sites, with current standard of care recommendations in the trauma patient.

  4. Describe the relevancy of peripheral arterial cannulation in the trauma setting.

  5. Present current recommendations regarding intraosseous access in the trauma patient.

INTRODUCTION

Advanced Trauma Life Support (ATLS) guidelines recommend that, in the initial management of hemorrhagic shock, prompt access must be obtained [1]. This is best accomplished by the insertion of two large-caliber (16 G angiocaths or larger) peripheral intravenous (IV) catheters before consideration is given to central venous catheters, or venous cutdowns [1]. Obviously, the condition of the arriving trauma patient, that is, massive extremity injury and extent of the injury, may not allow for any reasonable peripheral venous access for IV insertion. This chapter reviews the management of intravascular access in the trauma patient in the hospital setting where definitive care is to be provided. The main areas to be covered include venous access as well as arterial access in critically injured patients. Clinical experience and evidence-based medicine is balanced to provide a framework for guiding the management of patients from a vascular access standpoint.

PERIPHERAL INTRAVENOUS (PIV) CATHETERS

Prior to arrival in the emergency department, PIV cannulation has usually been performed in the field by prehospital personnel [1, 2].

Type
Chapter
Information
Trauma Anesthesia , pp. 69 - 80
Publisher: Cambridge University Press
Print publication year: 2008

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  • Establishing Vascular Access in the Trauma Patient
    • By Matthew A. Joy, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Donn Marciniak, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Kasia Petelenz-Rubin, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.007
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  • Establishing Vascular Access in the Trauma Patient
    • By Matthew A. Joy, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Donn Marciniak, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Kasia Petelenz-Rubin, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.007
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Establishing Vascular Access in the Trauma Patient
    • By Matthew A. Joy, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Donn Marciniak, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Kasia Petelenz-Rubin, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.007
Available formats
×