eMedicine Specialties > Pediatrics: Surgery > Vascular Surgery

Vascular Access: Surgical Perspective: Multimedia

Author: Shawn D Larson, MB, ChB, General Surgery Resident, Department of Surgery, University of South Florida; Former Resident Research Fellow, Department of Surgery, The University of Texas Medical Branch
Coauthor(s): Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina; Ramanathan Raju, MD, MBA, CPE, FRCS, FACS, Medical Director and Director of Medical Education, Coney Island Hospital; Clinical Professor of Surgery, New York College of Osteopathic Medicine, Associate Clinical Professor of Surgery, SUNY Health Sciences Center; Steve Lee, MD, Physician in Plastic, Reconstructive, and Hand Surgery, Plastic Surgery, PLLC
Contributor Information and Disclosures

Updated: Oct 16, 2006

Multimedia

Percutaneous external jugular vein access. Note ...Media file 1: Percutaneous external jugular vein access. Note that the head is in the dependent position to allow for filling of the vein.
Percutaneous external jugular vein access. Note ...

Percutaneous external jugular vein access. Note that the head is in the dependent position to allow for filling of the vein.

Saphenous vein cutdown. Note the relationship of ...Media file 2: Saphenous vein cutdown. Note the relationship of the saphenous vein to the medial malleolus. A linear incision is made perpendicular to the vein.
Saphenous vein cutdown. Note the relationship of ...

Saphenous vein cutdown. Note the relationship of the saphenous vein to the medial malleolus. A linear incision is made perpendicular to the vein.

Saphenous vein venotomy. A venotomy is made duri...Media file 3: Saphenous vein venotomy. A venotomy is made during saphenous vein cutdown with a number 11 blade (or iris scissors). Care must be taken to avoid complete transection of the vein. The venotomy should be made parallel with the vein to avoid this complication.
Saphenous vein venotomy. A venotomy is made duri...

Saphenous vein venotomy. A venotomy is made during saphenous vein cutdown with a number 11 blade (or iris scissors). Care must be taken to avoid complete transection of the vein. The venotomy should be made parallel with the vein to avoid this complication.

Insertion of the saphenous vein catheter. After t...Media file 4: Insertion of the saphenous vein catheter. After the vein is located and venotomy performed, the catheter is inserted into the vein. Use of the proximal suture loop can facilitate catheter placement.
Insertion of the saphenous vein catheter. After t...

Insertion of the saphenous vein catheter. After the vein is located and venotomy performed, the catheter is inserted into the vein. Use of the proximal suture loop can facilitate catheter placement.

Venous drainage of the bone marrow. The venous n...Media file 5: Venous drainage of the bone marrow. The venous network of the bone marrow is used for intraosseous puncture to obtain vascular access.
Venous drainage of the bone marrow. The venous n...

Venous drainage of the bone marrow. The venous network of the bone marrow is used for intraosseous puncture to obtain vascular access.

Lower-extremity anatomy for intraosseous vascular...Media file 6: Lower-extremity anatomy for intraosseous vascular access. The intraosseous needle is placed approximately 1-3 cm below the tibial tuberosity.
Lower-extremity anatomy for intraosseous vascular...

Lower-extremity anatomy for intraosseous vascular access. The intraosseous needle is placed approximately 1-3 cm below the tibial tuberosity.

Percutaneous subclavian vascular access. Anatomic...Media file 7: Percutaneous subclavian vascular access. Anatomic landmarks should be clearly identified before vascular access is attempted. The needle is guided toward the sternal notch.
Percutaneous subclavian vascular access. Anatomic...

Percutaneous subclavian vascular access. Anatomic landmarks should be clearly identified before vascular access is attempted. The needle is guided toward the sternal notch.

Percutaneous internal jugular venous access. The ...Media file 8: Percutaneous internal jugular venous access. The anatomic landmarks and the carotid artery must be clearly identified before venous access is attempted. The carotid artery lies medial to the vein. The needle is inserted at the apex of the triangle formed by the 2 heads of the sternocleidomastoid muscle.
Percutaneous internal jugular venous access. The ...

Percutaneous internal jugular venous access. The anatomic landmarks and the carotid artery must be clearly identified before venous access is attempted. The carotid artery lies medial to the vein. The needle is inserted at the apex of the triangle formed by the 2 heads of the sternocleidomastoid muscle.

Umbilical vein catheterization. A, Umbilical tape...Media file 9: Umbilical vein catheterization. A, Umbilical tape or silk suture is looped around the base of the umbilicus, and the distal umbilical stump is removed. B, The umbilical vein is located (usually in the 12-o'clock position), and the lumen is exposed. C, The catheter is advanced into the lumen. D, After a satisfactory position is achieved, the catheter is secured in place.
Umbilical vein catheterization. A, Umbilical tape...

Umbilical vein catheterization. A, Umbilical tape or silk suture is looped around the base of the umbilicus, and the distal umbilical stump is removed. B, The umbilical vein is located (usually in the 12-o'clock position), and the lumen is exposed. C, The catheter is advanced into the lumen. D, After a satisfactory position is achieved, the catheter is secured in place.

Arterial cannulation of the radial artery. Two fi...Media file 10: Arterial cannulation of the radial artery. Two fingers are placed at the wrist to locate and help visualize the course of the artery. The artery is then cannulated after collateral flow is assessed (Allen test).
Arterial cannulation of the radial artery. Two fi...

Arterial cannulation of the radial artery. Two fingers are placed at the wrist to locate and help visualize the course of the artery. The artery is then cannulated after collateral flow is assessed (Allen test).

Algorithm for emergency venous access. IV = intra...Media file 11: Algorithm for emergency venous access. IV = intravenous.
Algorithm for emergency venous access. IV = intra...

Algorithm for emergency venous access. IV = intravenous.

More on Vascular Access: Surgical Perspective

References

References

  1. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support Student Course Manual. 2004;7th ed.

  2. Bagwell CE, Salzberg AM, Sonnino RE, et al. Potentially lethal complications of ventral venous catheter placement. J Ped Surgery. 2000;35(5):709-713. [Medline].

  3. Chiang VW, Baskin MN. Uses and complications of central venous catheters inserted in a pediatric emergency department. Pediatric Emergency Care. 2000;16(4):230-232. [Medline].

  4. Chung DH, Ziegler MM. Central venous catheter access. Nutrition. Jan 1998;14(1):119-23. [Medline].

  5. Othersen HB Jr, Hebra A, Chessman KH, et al. Central lines in parenteral nutrition. In Baker RD Jr, Baker SS, Davis AM, eds. Pediatric Parenteral Nutrition. New York: Chapman and Hall;. 1997;254-71.

  6. Smith R, Davis N, Bouamra O, Lecky F. The utilization of intraosseous infusion in the resuscitation of paediatric major trauma patients. Injury. Sep 2005;36(9):1034-8; discussion 1039.

  7. Stovroff M, Teague WG. Intravenous access in infants and children. Pediatr Clin North Am. Dec 1998;45(6):1373-93, viii. [Medline].

Further Reading

Keywords

vascular access, intraosseous access, peripheral venous access, percutaneous peripheral catheters, peripheral venous cutdown catheters, intraosseous catheters, central venous access, peripheral intravenous central catheters, PICC lines, central venous catheters, percutaneous polyethylene catheters, silastic central venous catheters, implantable access ports, umbilical vascular access, arterial cannulation, complications of vascular access

Contributor Information and Disclosures

Author

Shawn D Larson, MB, ChB, General Surgery Resident, Department of Surgery, University of South Florida; Former Resident Research Fellow, Department of Surgery, The University of Texas Medical Branch
Shawn D Larson, MB, ChB is a member of the following medical societies: American College of Surgeons and Society for Surgery of the Alimentary Tract
Disclosure: Nothing to disclose.

Coauthor(s)

Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

Ramanathan Raju, MD, MBA, CPE, FRCS, FACS, Medical Director and Director of Medical Education, Coney Island Hospital; Clinical Professor of Surgery, New York College of Osteopathic Medicine, Associate Clinical Professor of Surgery, SUNY Health Sciences Center
Ramanathan Raju, MD, MBA, CPE, FRCS, FACS is a member of the following medical societies: American Association for the Advancement of Science, American College of Angiology, American College of Critical Care Medicine, American College of Phlebology, American College of Physician Executives, American Society of Abdominal Surgeons, American Trauma Society, Association for Academic Surgery, Association for Surgical Education, International College of Surgeons, International College of Surgeons US Section, New York Academy of Sciences, New York County Medical Society, Royal College of Surgeons of England, Society of Critical Care Medicine, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Steve Lee, MD, Physician in Plastic, Reconstructive, and Hand Surgery, Plastic Surgery, PLLC
Steve Lee, MD is a member of the following medical societies: American College of Surgeons and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Jonah Odim, MD, PhD, MBA, Senior Medical Officer, Transplantation Immunology Branch, Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health
Jonah Odim, MD, PhD, MBA is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physician Executives, American College of Surgeons, American Heart Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, Association for Academic Surgery, Association for Surgical Education, Canadian Cardiovascular Society, International Society for Heart and Lung Transplantation, National Medical Association, New York Academy of Sciences, Royal College of Physicians and Surgeons of Canada, Society of Critical Care Medicine, and Society of Thoracic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

John Myers, MD, Director, Pediatric and Congenital Cardiovascular Surgery, Departments of Surgery and Pediatrics, Professor, Penn State Children's Hospital, Milton S Hershey Medical Center
John Myers, MD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Cardiology, American College of Surgeons, American Heart Association, American Medical Association, Congenital Heart Surgeons Society, Pennsylvania Medical Society, and Society of Thoracic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Mary C Mancini, MD, PhD is a member of the following medical societies: American Heart Association, American Medical Association, American Thoracic Society, Association for Academic Surgery, Association for Surgical Education, International College of Surgeons, International Society for Heart and Lung Transplantation, New York Academy of Sciences, Phi Beta Kappa, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

 
 
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