Table Of ContentUltrasound
Guided Vascular
Access
Practical Solutions to Bedside
Clinical Challenges
Matthew D. Ostroff
Mark W. Connolly
123
Ultrasound Guided Vascular Access
Matthew D. Ostroff • Mark W. Connolly
Ultrasound Guided Vascular
Access
Practical Solutions to Bedside Clinical
Challenges
Matthew D. Ostroff Mark W. Connolly
Division of Vascular Access Division of Cardiothoracic Surgery
St. Joseph’s University Health St. Joseph’s University Health
Paterson, NJ, USA Paterson, NJ, USA
ISBN 978-3-031-18613-4 ISBN 978-3-031-18614-1 (eBook)
https://doi.org/10.1007/978-3-031-18614-1
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Foreword
Empathy is one of the hallmarks of the practice of medicine. We read, study, and
communicate, but at some point, often with sharp objects in hand, we step into
another person’s personal space. During those moments, beside this person who has
entrusted us with their health and safety, we reach a level of compassion beyond the
scope of many professions.
Placing a needle in a vein is one of our most common practices and arguably the
most symbolic. It is the space where our training, practice, and knowledge become
both personal and physical. Hunkered down next to those in our care, we hold them
in our hands and discover what cannot often be seen from the surface. In a way, the
IV line itself represents the connection between the patient and the world of medi-
cine. Both the patient and care provider strive to make the interaction and process as
brief and painless as possible.
When approaching a new patient, I bring with me the lessons I have learned from
the patients I’ve cared for and from the countless nurses, doctors, and other provid-
ers with whom I have worked alongside. These valuable insights guide my hand,
helping me to transform the challenges of prior cases into a simpler and more effi-
cient experience in the present. Over the past 20 years, I’ve also witnessed and
imparted the crucial role that point-of-care ultrasound plays in our patient care.
Ultrasound technology allows us to leverage our skills to practice at the top of our
game, speeding diagnosis and making procedures safer.
I first met Matthew D. Ostroff while working in the emergency department. He
was always innovating new approaches that would benefit his patients. Inspired by
his passion for improving patient care at the bedside, he learned every technique
from every person he could and listened to his patients to hone the skill for
ultrasound- guided vascular access.
Many different types of care providers, and in turn their patients, will benefit
from the cases in this book. In reading them, you will see a pragmatic approach to
vascular access problem-solving that you can employ in your daily practice. You
will be introduced to dozens of patients who benefitted from a thoughtful approach
to vascular access that I am confident improved their care and reduced the potential
v
vi Foreword
for pain and complications. Mr. Ostroff does a great service to all of us by sharing
what he has learned over the years; we would do well to continue to share our best
practices with each other as we care for patients together.
Department of Emergency Medicine, Bret Nelson
Emergency Ultrasound Division
Icahn School of Medicine at Mount Sinai
New York, NY, USA
Preface
From the great pioneers to today’s innovators, vascular access clinicians have been
and continue to be fueled by this basic question “How can we improve vascular
access for both the patient and clinician?”.
A clinician’s success is dependent on a detailed knowledge of the anatomy, fine
motor skills, a background in infusion therapy, technology, and a little imagination.
In the hands of a specialist, ultrasound guides the user through the body, enabling
visual clarity and assessment to achieve vascular access in almost any patient.
Ultrasound has completely transformed the vision and reach of the vascular access
specialty at bedside.
A specialty cannot evolve in the hospital setting without the support of an admin-
istration, the confidence of fellow providers, and the bond and trust established with
the patient, especially in their moments of greatest need. As care providers, we must
answer the challenge to treat patients who do not fit the standard guidelines and
protocols.
Covering a vascular access specialist’s journey and practice in a 700-bed trauma
center with a very complex patient population, this book demonstrates the possibili-
ties of bedside vascular access from the tiniest neonate to the most critical care
adult. Each chapter studies cases with some of the most challenging situations
encountered in the hospital setting and includes process descriptions of how these
challenges were met and leaves the reader with key take away points. Less of a
protocol and guideline and more of a real-life look into patients that do not fall
within our traditional practices, this book was written to help clinicians of all back-
grounds think outside the box and find practical solutions. The references in each
chapter were carefully selected to expand understanding and satisfy curiosity.
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viii Preface
It is the patients that continue to inspire us to push limits and find the very best
in care. No one should have to suffer from repeated attempts and complications
associated with vascular access. As future generations of practitioners evolve and
the patient experience improves, what can never change in this specialized practice
is applying both compassion and innovation to transform current thinking from
what should be done to what can be done.
Paterson, NJ, USA Matthew D. Ostroff
Acknowledgments
Matthew D. Ostroff and Dr. Mark W. Connolly would like to acknowledge the sup-
port of the vascular access program by the CEO and his administration, the medical,
surgical, and nursing departments, and child life specialists at St. Joseph’s
University Health.
Matthew would like to personally acknowledge his mentors, Dr. Mauro Pittiruti,
Dr. Jack Ledonne, Dr. Bret Nelson, Dr. Nancy Moureau, Dr. Evan Alexandrou, Dr.
James, Dr. Beniwal, Dr. Ismail, Dr. Rae, Dr. Debruin, Dr. Messina, Dr. Zauk, Dr.
Symington, Gail Egan, Andrea Musaro, Holly Hess, Marcia Wise, and Dr. Elijah
Salzer. He would like to pay special regards to his colleagues from the Association
for Vascular Access, the World Congress on Vascular Access, and GAVeCeLT. He
would also like to thank the vascular access device industry for listening to clini-
cians and creating the tools necessary to improve care for all patient populations. He
is eternally grateful to his friend and colleague Bart Rice who advised him one
Friday afternoon at 3pm that St. Joseph’s was looking to create a vascular access
program which changed the course of his career. He would like to extend his deep-
est gratitude to his collaborative physician Dr. Mark Connolly for believing in his
vision and supporting each and every innovation in patient care. He would like to
recognize his Chief Nursing Officer, Dr Kevin Browne, his Director, Debbie Smith,
and the invaluable vascular access team of Toni Ann Weite, Donnette Miller, Daniel
Garcia, Olena Stanko, Jane Ahn, Kirsten Anderson, Jennifer Hunter, Adrian
Sanchez, Claudia Caro, Kate Bivona, and Jennifer Albano, all of whom he is so
proud to work beside each and every day. This book would not have been possible
without the extraordinary assistance of our Assistant Librarian, Jessica Escobar. He
is extremely grateful to Kim Suarez for her love, guidance and support, making him
realize that the dream of writing a book could come true. He would also like to
thank his parents, his brother Adam, and most importantly his four children,
Madison, Jordan, Carter, and Hunter, for their love and support and for giving him
the best reason to come home. Finally, this project would not have been possible
without our patients who inspire us all to continue pushing the boundaries of what
is possible at the bedside in vascular access.
ix
Contents
Part I Ultrasound Guided Peripheral Intravenous Catheters (PIVC)
1 Ultrasound Guided Small-bore Peripheral Catheter Placement
for Large Volume Therapeutic Phlebotomy . . . . . . . . . . . . . . . . . . . . . 3
2 Infusion and Phlebotomy via the Femoral Vein in Outpatient
Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3 Ultrasound Guided Peripheral Intravenous Catheter
to the Brachial Vein During a Rapid Response . . . . . . . . . . . . . . . . . . 13
4 Ultrasound Guided Long Peripheral Catheter to the Basilic
Vein to Facilitate a Rapid Transfusion . . . . . . . . . . . . . . . . . . . . . . . . . 17
5 Vascular Access in the Bariatric Patient . . . . . . . . . . . . . . . . . . . . . . . . 23
6 Use of the External Jugular Vein in the End Stage
Renal Disease Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
7 Administering Palliative Care with a Midline Catheter
to the Superficial Femoral Vein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
8 Vasopressors Through a Peripheral Intravenous
Catheter as a Bridge to Establishing Central Venous Access . . . . . . . 39
9 Netherton Syndrome and Use of the Cephalic
Vein in the Forearm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
10 Use of a Neonatal Double Lumen Peripherally Inserted
Central Catheter as a Double Lumen Peripheral Intravenous
Catheter in the Geriatric Patient with Limited Vasculature . . . . . . . . 53
11 Use of the Great Saphenous Vein in Pediatrics . . . . . . . . . . . . . . . . . . 57
12 Downgrading Central Venous Access with Dual Ipsilateral
Midlines Catheters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
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