Since their first application in 1982, Totally Implantable Venous Access Devices (TIVADs) have become increasingly important in the clinical practice, as more intensive chemotherapy and parenteral treatments have come into use. At this time, there is objective evidence that TIVADs are a safe, effective strategy for long-term venous access; they play a significant role throughout the management of the oncology patient, as they are needed in the initial phases for active treatments as well as in the last stages for palliative measures, making possible repeated administration of chemotherapeutic vesicant agents, nutrients, antibiotics, analgesics, and blood products. According to a number of prospective studies, use of TIVADs is associated with a significant complication rate (10% to 25% of all patients). Evidence-based data support that most complications are directly related to inappropriate technique of placement and/or nursing care, sometimes leading to TIVAD loss, significant morbidity, increased duration of hospitalization, and additional medical cost. A group of world-renowned experts - both in the clinical and research fields – contributed to this volume, whose aim is to provide clinicians, nurses and medical students with a multidisciplinary, full update on these devices, as long term central venous access can no be longer considered a routine matter, and serious complications can be maintained at a very low level only if strict adherence to a well-defined protocol of surgical technique and of catheter care is maintained.

This book addresses all the issues a patient may experience prior to receiving a VAD. Selection of equipment, practical aspects of technique, the pros and cons of the various veins, and modifications of technique for certain circumstances are examined. Covereage also includes the roles played by radiologists, anaesthetists, surgeons, nurses, and other team memebers. Throughout the chapters a reference is made to the IV Therapy Standards published by the Royal College of Nursing IV Therapy Forum in 2003. Each chapter is evidence based and fully referenced.

Central venous access devices (CVADs) are used within a variety of areas in both hospital and community health care settings to administer blood or fluids, to provide long term access for repeat transfusion of blood or blood products, chemotherapy, parenteral nutrition and antibiotic therapy, and to provide immediate access in emergency situations. Central venous access devices is a practical guide to the care and management of CVADs aimed at student nurses, newly qualified nurses and more experienced nurses who are unfamiliar in dealing with these devices. Central venous access devices addresses patient assessment and education, relevant anatomy and physiology, appropriate device selection, and guidelines on insertion, follow-up care and management of CVADs. Each category of CVAD - including peripherally inserted central catheters, non tunnelled central venous catheters, skin tunnelled catheters and implanted ports - is explored in turn. Concluding chapters explore hazards of insertion, prevention and management of complications, and patient perspectives on living with a CVAD

This Open access book offers updated and revised information on vessel health and preservation (VHP), a model concept first published in poster form in 2008 and in JVA in 2012, which has received a great deal of attention, especially in the US, UK and Australia. The book presents a model and a new way of thinking applied to vascular access and administration of intravenous treatment, and shows how establishing and maintaining a route of access to the bloodstream is essential for patients in acute care today. Until now, little thought has been given to an intentional process to guide selection, insertion and management of vascular access devices (VADs) and by default actions are based on crisis management when a quickly selected VAD fails. The book details how VHP establishes a framework or pathway model for each step of the patient experience, intentionally guiding, improving and eliminating risk when possible. The evidence points to the fact that reducing fragmentation, establishing a pathway, and teaching the process to all stakeholders reduces complications with intravenous therapy, improves efficiency and diminishes cost. As such this book appeals to bedside nurses, physicians and other health professionals.

Indications for central venous cannulation in critically ill patients have increased dramatically, but central venous access has the drawbacks of morbidity and a scarcity of experienced operators. Ultrasound-guided peripheral venous access offers a solution, in that it reduces morbidity and can be performed by a dedicated nursing team. The aim of this book is to teach the fundamentals of this emerging technique. Advice is provided on choice of materials; maneuvers for positioning of peripherally inserted central venous catheters (PICCs), techniques for evaluation of PICC tip placement; prevention, diagnosis, and management of complications; and organization of a dedicated team within a hospital or a supportive care program. Legal and economic issues are also considered. The book will be of interest to a wide range of professionals, including nutritionists, oncologists, anesthesiologists, surgeons, registered nurses, nurse practitioners, physicians, physician assistants, and radiologists.

This book focuses on the placement of vascular access devices under emergent conditions, including the techniques and devices needed to achieve successful device deployment in even the most critically-ill patient. Up-to-date references and evidence for best practices are provided, informing both the novice and experienced healthcare provider. Each chapter is meticulously researched, including individual chapters focusing upon peripheral intravenous, intraosseous, central venous, and ultrasound-guided catheter placement. Device selection and emergent decision-making are discussed at length, including such crucial determinants as infusion flow rates, device limitations, issues with medication incompatibility, complications of line placement, and the relative indications and contraindications associated with various vascular access approaches. Emergent Vascular Access is an essential resource for any healthcare provider who places or manages vascular access devices in critically-ill patients, including emergency and ICU physicians, residents, rapid response providers, EMS paramedics, patient care technicians, medical students, and nurses.

EMERGENCY MANAGEMENT OF THE HI-TECH PATIENT IN ACUTE AND CRITICAL CARE Emergency Management of the Hi-Tech Patient in Acute and Critical Care helps practitioners stabilize and care for pediatric and adult patients who have specialized medical devices such as prosthetic valves, cochlear transplants, insulin pumps, orthopedic hardware, and ventriculoperitoneal (VP) shunts. Using a step-by-step approach to acute presentations of patients with clinical hardware, this concise yet comprehensive guide provides specific instructions for the initial evaluation and management of numerous clinical scenarios including device malfunctions, infections, trauma, surgical complications, and more. Encompassing management of both the patient and the device, the guide enables emergency and critical care clinicians to rapidly make appropriate treatment decisions without the immediate need for extensive research, extended discussions with subspecialists, or recalling complex diagnostic and therapeutic algorithms. Clear, concise, and easy-to-follow chapters—written by a panel of highly experienced experts across specialties—include numerous algorithms, figures, tables, diagrams, and color illustrations and clinical images. An invaluable resource for improving the quality of care for the unique hi-tech patient population, this advanced practical manual: Provides algorithms for the most common clinical scenarios of device malfunction and related complications Covers management of patients who have undergone major operations such as organ transplantation or complex congenital heart disease repair Presents detailed management plans for a wide range of hardware types and medical conditions Offers expert guidance to practitioners in settings where not all specialties are readily available, such as rural and remote areas or community hospitals Features contributions from a team of experts in various areas of adult and pediatric emergency and critical care medicine Emergency Management of the Hi-Tech Patient in Acute and Critical Care is a must-have clinical reference and guide for pediatric and adult emergency medicine physicians, general pediatricians, internists, general practitioners, critical care specialists, and allied health practitioners.