EMERGENCY DEPARTMENT
VASCULAR ACCESS CASES

Bilateral Amputation Requires Emergent Vascular Access | NCIA-26

Emergency Department Vascular Access Cases: A teen patient who suffered life-threatening bilateral arm amputation in an accident was admitted to the Trauma unit with massive blood loss. The Trauma physicians made several unsuccessful attempts to place a central line and quickly switched to a Femoral approach. They obtained access, but the line was positional, making it less reliable. Seeing the urgency of the situation, the charge nurse acted quickly and asked the Vascular Wellness Clinician to come to the trauma room. Understanding the dire situation, the Vascular Wellness clinician quickly and successfully inserted a triple lumen catheter using ultrasound guidance into the right jugular vein, which was immediately utilized by the team saving this teenagers life. The Vascular Wellness nurse clinician suggested an additional central line be placed opposite of the positional left-sided femoral vein. The trauma physicians agreed, and this Mid-Thigh Femoral line was placed successfully on the first attempt and the positional line placed by the physician was removed. With two central lines in place, the trauma team was able to stabilize the patient for transport. During the patient’s three-week stay in the Pediatric ICU recovery unit, he was able to keep the stable central line access until it was no longer needed.

Patient with 14 Failed Peripheral IV Sticks | NCIA-08

Emergency Department Vascular Access Cases: A male patient in an Emergency Department needed a Peripheral IV (PIV) for blood work. The emergency department physicians tried to achieve access 14 times without success, due in large part to the fact that the patient was a heavy-set man with deeper veins. Not only was the patient very angry and frustrated from having received many painful sticks, but the hospital staff had opened and used 14 PIV kits and the much-needed vascular access still had not been achieved. At that point, Vascular Wellness was contacted, and a Vascular Access Board Certified nurse clinician arrived. The clinician quickly realized that he first had to calm the patient down and earn his trust in order to perform the procedure. The Vascular Wellness nurse took the time to explain the procedure, and shared that he would be using ultrasound guidance so he could visualize exactly where the vein was, and how it ensured that he would be successful on the first attempt. With permission, he put the ultrasound on his arm so that the patient could see his vein clearly, and even offered lidocaine to numb the area, but the patient felt so comfortable at that point that he declined. After vascular access was achieved, the patient thanked the Vascular Wellness clinician and said, “where were you 2 hours ago?”