Vascular Access

[size=6]A 5-week-old 3 kg infant is in the ED with bilious emesis. The infant is lethargic and dehydrated. The ED has not been able to obtain peripheral IV access. What is the best next step to secure urgent vascular access? a Saphenous vein catheter b Umbilical vein catheter c Intraosseous access d Internal jugular vein catheter[/size]

Any one want a high quality PDF of this chart, post in this thread, use a personalized picture as an avatar, and have three threads in the forums, I will send it to you in a private message Edit: available without restrictions [color=#3300ff][/color]

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An 8 year-old girl requires exchange of her existing left internal jugular port-a-catheter to a hemodialysis catheter due to a failing renal transplant. She has a history of multiple previous hemodialysis catheters and central venous stenosis. During catheter placement, serial dilations of the central venous stenosis are performed over a wire and she becomes hypotensive and bradycardic. Her heart rate and blood pressure (60/40) improve with epinephrine and the last fluoroscopic image is shown below. What is the best next step in management? [size=20px]A Echocardiogram B Insert a right chest tube C Right thoracotomy D Left thoracotomy E Median sternotomy…

[size=20px]Compared to centrally inserted venous catheters, peripheral inserted central catheters (PICCs) are associated with a higher rate of a catheter patency. b catheter fracture. c central line associated blood stream infection (CLABSI). d deep venous thrombosis. e pulmonary embolism.[/size]

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[center] Open CVP Catheter Insertion. Internal jugular vein Cutdown. By Dr Tamer Ashraf Wafa, PhD, MRCS see in next post [/center]

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First one with correct answer with justification win. [size=20px]A nine-year old boy has completed treatment for acute lymphoblastic leukemia. An implanted resevoir for vascualr access was placed via a percutaneous left subclavian vein approach four years prior. A request was made for its removal by the Hematology-Oncology Service. At surgery, the port was mobilized without difficulty. However, the catheter could not be withdrawn despite a prolonged attempt at providing tension on the catheter. Dissection was undertaken to the infraclavicular area but the catheter could still not be withdrawn. The next best step in management of this child with a difficult port remo…

[b]IPSO Practice Guidelines on Venous Access for the Pediatric Cancer Patient[/b]

First one with correct answer with justification win. [size=20px]Upon emergence from general anesthesia after percutaneous placement of a left internal jugular dialysis catheter, a patient is noted to be hypotensive with a blood pressure of 70/50 and increased central venous pressure. Breath sounds are equal bilaterally but jugular veins are distended with muffled heart tones. The next best step in management of this patient with hypotension is A fluid resuscitation. B vasopressors. C pericardiocentesis. D echocardiography. E tube thoracostomy.[/size]