Internal Jugular Vascular Access Cases

Vascular Access for Surgical Rehabilitation Patient | NCIA-30

Internal Jugular Vascular Access Cases: A patient in a Rehabilitation Facility was recovering from bowel surgery and had a potential surgical site infection and bilateral swelling due to post-operative restraints. Because the patient’s poor peripheral veins made vascular access difficult, the facility could not obtain blood lab samples to confirm the suspected infection. Vascular Wellness was consulted to place a midline for antibiotic IV therapy. Upon arrival and evaluation of the patient and medical history, the Vascular Wellness clinician found co-morbidities and bilateral swelling in the arms after an ultrasound assessment of both arms. Understanding the prescribed line would create additional complications, she discussed her concerns with her Vascular Wellness colleagues. She suggested a diagnostic ultrasound to rule out a possible DVT in the right arm and shared that a midline was no longer preferred due to the risk of secondary DVT in the left arm if placed there. The LIP requested an ultrasound-guided left arm PIV, but this was not possible due to vein size and swelling. Ultimately, the clinician recommended an Internal Jugular central line, and the care team agreed to proceed with an IJ catheter, which would significantly reduce the risk of a secondary DVT.  The insertion procedure and blood collection were performed without difficulty, allowing for rapid delivery of the prescribed therapy.

Implanted Port Obstructs PICC Insertion | NCIA-29

Internal Jugular Vascular Access Cases: A patient with pre-existing vascular access devices needed additional access for multiple infusions and intravenous nutritional support. The Vascular Wellness clinician and medical team agreed that a PICC line would be ideal, but during the procedure, the clinician quickly determined that a pre-existing port was obstructing the passage of the PICC and preventing it from being properly placed. An earlier chest X-ray showed that the implanted port was in a shallow position in the Superior Vena Cava (SVC), and because the ordered therapy required a deep SVC location for proper hemodilution, the clinician determined the port would block access to the required deeper location for the PICC. The clinician then recommended a Small-Bore Internal Jugular catheter on the right side to avoid the port catheter, the medical team agreed that this was an excellent solution, and the line was placed on the first attempt without issues. The line was verified and the patient was able to receive the prescribed therapies at the bedside without delay.

PICU PATIENT NEEDS ADDITIONAL VASCULAR ACCESS | NCIA-21

Internal Jugular Patient Cases: a two-month old patient in the PICU was suffering from Respiratory Syncytial Virus (RSV) and pneumonia. The infant needed peripheral IV access, but the PICU nurses attempts to gain vascular access were unsuccessful. A Vascular Wellness clinician was called to place an ultrasound-guided PIV, which was achieved without incident. A short while later, the infant’s condition again declined, and additional vascular access was necessary for the use of Vasopressors. The pediatric intensivist attempted both femoral and internal jugular access without success. Smaller veins of a pediatric patient can make achieving vascular access more difficult, so the Vascular Wellness clinician who had just departed was made aware of the emergent condition and immediately returned to the hospital. The atmosphere was tense in the PICU, but the clinician conducted a rapid ultrasound scan on the infant and determined that a left-sided internal jugular CVC could be placed safely. The line was placed on the first attempt without complication, and additional therapies began immediately.