[Emergency and temporary vascular access].
The vascular access in emergency represents a basic need for every nephrologist in order to realize an extracorporeal circuit necessary to perform hemodialysis and many other derived therapies. In the eighties a progressive abandonment of the external shunt was noted with a concomitant increase of vena cava catheterization simpler to perform, especially under echographic control, and made increasingly possible by continuous technological improvements. The femoral access is utilized in about 30% of cases, especially in critically ill patients, due to easy performing procedures and few complications. Subclavian vein is abandoned as a first choice in favour of the jugular vein due to frequent and severe early complications and to thrombo-stenotic lesions observed in about 50% of catheterizations. Prevention and rapid treatment of the complications and careful management have an important role in obtaining a prolonged catheter survival. Even if, when possible, the classical arterio-venous fistula remains the ideal solution, at least in particular patient categories a jugular vein utilization as permanent access is justified.
Paternoster
G
G
Servizio di Nefrologia e Dialisi, Ospedale Regionale, Aosta.
Molino
A
A
Alloatti
S
S
D001166:Arteriovenous Shunt, Surgical; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods / Q000451:nursing; D002408:Catheters, Indwelling / Q000009:adverse effects; D003422:Critical Care / Q000379:methods*; D004632:Emergency Medical Services; D004866:Equipment Contamination; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007239:Infections / Q000209:etiology; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000601:surgery; D006435:Renal Dialysis / Q000379:methods; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000601:surgery; D013927:Thrombosis / Q000209:etiology; D014463:Ultrasonography
L'accesso vascolare d'emergenza e temporaneo.