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Bradley W. Frazee - One of the best experts on this subject based on the ideXlab platform.
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ultrasonographically guided insertion of a 15 cm catheter into the deep brachial or Basilic Vein in patients with difficult intravenous access
Annals of Emergency Medicine, 2007Co-Authors: Christopher N Mills, Otto Liebmann, Michael B Stone, Bradley W. FrazeeAbstract:Study objective Standard length (3 to 5 cm) intravenous catheters in the deep brachial or Basilic Vein tend to dislodge prematurely. We assess the safety and longevity of a 15-cm catheter inserted in these Veins by a novel ultrasonographically guided technique. Methods This is a prospective cohort study conducted in an urban teaching emergency department (ED). Adult subjects were enrolled if 2 peripheral intravenous insertion attempts had failed. A 3.2-cm, 18-gauge catheter was first inserted into the deep brachial or Basilic Vein under ultrasonographic guidance. In a separate step, a wire was inserted through this catheter, and a 15-cm, 16-gauge catheter was placed over the wire and left in place for up to 3 days. Primary outcomes were time to securing access and rate of loss of access. Secondary outcomes included complication rates and subject satisfaction. Results Twenty-five subjects were enrolled; 23 catheters were successfully placed. Median time required for initial Vein cannulation was 3 minutes (interquartile range [IQR] 2 to 7 minutes) and for securing the 15-cm catheter was an additional 4 minutes (IQR 3 to 5 minutes). Median duration of access was 26 hours (IQR 10 to 47 hours). The only complication was early infiltration in 1 subject. All subjects rated satisfaction as 4 or 5 on a 5-point Likert scale. Conclusion We present a promising alternative to central venous catheterization in patients with difficult intravenous access. This technique appears to be fast, safe, and well tolerated by adult patients.
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ultrasound guided deep brachial and Basilic Vein cannulation in the emergency department
Western Journal of Emergency Medicine, 2005Co-Authors: Ralph Wang, Eric R. Snoey, Bradley W. FrazeeAbstract:Page 38 The California Journal of Emergency Medicine VI:2, Apr-Jun, 2005 CalJEM PEARLS Ultrasound-Guided Deep Brachial and Basilic Vein Cannulation in the Emergency Department Ralph Wang, MD Eric Snoey, MD Brad Frazee, MD Department of Emergency Medicine Alameda County Medical Center Oakland, California Vein. 1 Recently, a novel approach was described using ultrasound to guide deep brachial cannulation. This approach resulted in a 91% success rate, with far fewer complications. 1 Our objective in this CalJEM article is to describe this ultrasound-guided technique, identify the appropriate patient population and indications, and review some shortcomings of the procedure. METHODS In general, the ultrasound-guided deep brachial line is used for patients with the following characteristics: --Require IV access --Lack discernable IV sites/fail previous IV attempts --Do not require central venous access Keyes et al. enrolled 101 ED patients who failed two IV attempts; 50% of the enrolled patients were injection drug users and 20% were noted to be obese. It was also noted that 8% of lines infiltrated or failed within one hour after cannulation; we feel that patients who are admitted or require long-term access should receive a second line. The materials required for the procedure are the same as standard peripheral IV starts with the exception of 2 items: the ultrasound and the catheter itself. The ultrasound most commonly used at Alameda County Medical Center Emergency Department is the SonoSite TITAN. The high resolution 7.5 MHz linear probe should be selected for vascular procedures. Due to the depth of the deep brachial Vein, a 1.8”, 18- or 20-gauge Angiocath TM IV catheter should be used. Step 1: Prepare the patient In order to expose the ulnar aspect of the arm, we have the patient lie in slight Trendelenberg, with their target arm abducted to 90 degrees and flexed at the elbow. The tourniquet is then applied and the skin is cleaned. A small amount of local anesthesia is appropriate. Correspondence: Ralph Wang, MD Highland General Hospital Department of Emergency Medicine Alameda County Medical Center 1411 E. 31 st St. Oakland, California 94602 INTRODUCTION Intravenous (IV) access is a common and essential emergency department procedure, which may be challenging in certain patients. Populations notorious for difficult IV access include injection drug users, diabetics, obese patients, or those in hypoperfusion states. Central venous catheter placement becomes the default solution when attempts at peripheral access prove unsuccessful. Yet, many patients do not meet general indications for central venous access, often only requiring brief administration of fluid or medication prior to discharge. Central venous catheterization may also be technically difficult, time consuming, and is associated with a variety of mechanical, thrombotic, and infectious complications. Deep brachial catheterization offers an alternative method of obtaining IV access. However, landmark- based approaches to the deep brachial Vein resulted in frequent complications, including brachial artery puncture, paresthesias, and failure to catheterize the
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Ultrasound-Guided Brachial and Basilic Vein Cannulation in Emergency Department Patients With Difficult Intravenous Access
Annals of emergency medicine, 1999Co-Authors: Linda E Keyes, Bradley W. Frazee, Eric R. Snoey, Barry C. Simon, David ChristyAbstract:Abstract Study objective: Emergency department patients who require intravenous access but lack peripheral intravenous sites frequently require central line placement. Blind percutaneous brachial Vein cannulation has been proposed as an alternative in these patients but is associated with high failure and complication rates. We evaluated an ultrasound-guided approach to percutaneous deep brachial Vein or Basilic Vein cannulation in ED patients with difficult intravenous access. Methods: We prospectively enrolled ED patients who required intravenous access in whom there had been 2 unsuccessful attempts at establishing a peripheral intravenous line. Using a 7.5-MHz ultrasound probe, the deep brachial Vein or Basilic Vein was identified and then cannulated with a 2-in, 18- to 20-gauge intravenous catheter. Time from probe placement to cannulation, number of attempts, and complications were recorded. Results: One hundred one patients were enrolled, of whom 50 were injection drug users and 21 were obese. Cannulation was successful in 91 patients (91%) and accomplished on the first attempt in 73 (73%). The mean (±SD) time required for cannulation was 77 seconds (±129, range 4 to 600 seconds). The line infiltrated or fell out within 1 hour of cannulation in 8 (8%) patients. One patient reported severe pain. There were 2 (2%) cases of brachial artery puncture. Conclusion: Ultrasound-guided brachial and Basilic Vein cannulation is safe, rapid, and has a high success rate in ED patients with difficult peripheral intravenous access. [Keyes LE, Frazee BW, Snoey ER, Simon BC, Christy D: Ultrasound-guided brachial and Basilic Vein cannulation in emergency department patients with difficult intravenous access. Ann Emerg Med December 1999;34:711-714.]
H Alkhaffaf - One of the best experts on this subject based on the ideXlab platform.
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the brachial artery Basilic Vein arterio venous fistula in vascular access for haemodialysis a review paper
European Journal of Vascular and Endovascular Surgery, 2006Co-Authors: F P Dix, Y Khan, H AlkhaffafAbstract:Aims. To review the available literature regarding patency rates and complications of the brachial-Basilic arterio-venous fistula (BBAVF) and to discuss this with relation to the current dialysis outcomes quality initiative guidelines. Methods. An internet based literature search was performed using Pubmed, Medline and Medscape databases to identify all published reports of the BBAVF in the English language from which the full articles were retrieved and cross-referenced. Results. Of 136 papers identified, 28 were directly relevant to this review including four prospective studies (one randomised trial, three non-randomised trials) and 24 retrospective studies. First described by Dagher in 1976, the BBAVF has since been modified to a two-stage procedure with initial fistula formation followed by superficialisation of the Basilic Vein 6 weeks later. It can be formed successfully in 95% of cases. Mean 1-year primary and secondary patency rates were 72 and 74.6%, respectively. Complications included haematoma (3.8%), stenosis (2.3%), thrombosis (9.7%), transient arm oedema (3.7%), steal syndrome (2.9%) and aneurysm/pseudoaneurysm formation (1.9%). The BBAVF had a lower rate of infection than prosthetic fistulas (3.6 vs. 16%). Conclusions. The BBAVF has good primary and secondary patency rates with lower rates of infection than prosthetic fistulas making it a preferred secondary access procedure.
V Dalainas - One of the best experts on this subject based on the ideXlab platform.
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transposed Basilic Vein brachial arteriovenous fistula an alternative vascular access for hemodialysis
Artificial Organs, 2008Co-Authors: A Hatjibaloglou, D Grekas, Nikolaos Saratzis, A Megalopoulos, I Moros, Dimitrios Kiskinis, V DalainasAbstract:Abstract: Twenty-five brachial-Basilic arteriovenous (AV) fistulas with transposed Basilic Vein for alternative vascular access were created in 22 chronic hemodialysis patients. This surgical procedure was performed under brachial block or general anesthesia. After a longitudinal skin incision that was made in the inner side of the arm, the Basilic Vein was exposed, transposed subcutaneously, and anastomosed end-to-side to the brachial artery. The follow-up was between 7 and 24 months. Early complications were hemorrhage, thrombosis, steal syndrome, and swelling of the arm. Among the late complications were failure of the fistula because of thrombosis and multiple stenosis at the site of venipuncture. The accumulated one-year patency rate of fistulas was 81%. The complications of high-output cardiac failure or local infection were not seen in our study. On the basis of our results, the brachial-Basilic AV fistula with transposed Basilic Vein is a useful and safe second- or third-choice vascular procedure for hemodialysis patients, in particular for women without good quality of vessels.
Mustafa Seren - One of the best experts on this subject based on the ideXlab platform.
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transposition of Basilic Vein in forearm for arteriovenous fistula creation our mid term results
Turkish Journal of Thoracic and Cardiovascular Surgery, 2019Co-Authors: Haci Alper Uzun, Omer Faruk Cicek, Mustafa SerenAbstract:Background: In this study, we aimed to present our mid-term results of Basilic Vein transposition in the forearm to create an arteriovenous fistula. Methods: Between January 2015 and October 2017, a total of 21 patients (13 males, 8 females; mean age 54.2±11.3 years; range, 32 to 74 years) with an adequate Basilic Vein and radial arterial systems who underwent Basilic Vein transposition in the forearm were retrospectively analyzed. All operations were performed under local anesthesia and mild sedation. The Basilic Vein was harvested using a single incision from elbow joint to wrist as an in situ Vein graft. If the harvested Basilic Vein did not extend easily to the radial artery in the wrist region, the saphenous Vein was harvested to extend arteriovenous fistula tract. Results: The mean follow-up was 25.3±9.8 (range, 2 to 32) months. All patients underwent arteriovenous access surgery using transposed Basilic Vein in the forearm. In all patients, except for two, transposed Basilic Vein in the forearm stayed patent during follow-up with a patency rate of 90.5%. The mean fistula maturation time was 45.2±10.7 (range, 28 to 59) days. Conclusion: If cephalic Vein diameters are too small for arteriovenous fistula creation, Basilic Vein system in the medial surface of the forearm may be considered a favorable option.
Wilfred I Carney - One of the best experts on this subject based on the ideXlab platform.
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comparison of Basilic Vein and polytetrafluoroethylene for brachial arteriovenous fistula
Journal of Vascular Surgery, 1994Co-Authors: Michael C Coburn, Wilfred I CarneyAbstract:Abstract Purpose: The aim of this study was to compare patency and complication rates between Basilic Vein and polytetrafluoroethylene (PTFE) for brachial arteriovenous fistulas (AVF) for long-term hemodialysis. Methods: All Basilic Vein and PTFE brachial AVF constructed between March 1988 and April 1993 were retrospectively reviewed. After construction of life-tables, log-rank testing was used to compare the primary patency rate of Basilic Vein AVF ( n = 59) with the primary and secondary patency rates of PTFE AVF ( n = 47). Complication rates were calculated for each type of fistula and compared by use of chi-squared testing. Results: The primary patency rate for Basilic Vein AVF (90%) was superior to that of PTFE AVF (70%) at 1 year ( p p p Conclusions: Basilic Vein AVF provided superior patency rates and lower complication rates compared with PTFE AVF. Prospective randomized trials comparing the two fistula types is required to firmly establish the Basilic Vein AVF as the alternative access procedure of choice after a failed or unconstructable radiocephalic fistula. (J VASC SURG 1994;20:896-904.)