Critical care clinics
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After two decades, hemodynamic invasive monitoring using a flow-directed, balloon-tipped, pulmonary artery (PA) catheter has established itself as a significant component of acute clinical care. In spite of continued recommendations for limitations, restrictions, moratoria, and even abandonment, growth in catheter use continues. Attempts to replace it by competing technologies for routine clinical practice have not been successful thus far. ⋯ After a brief history, this article focuses on the technical aspects of the insertion procedure, choice of hardware, and acquisition and analysis of information. Indications, contraindications, and clinical utility are briefly described. Major complications from PA catheterization reported in the literature since clinical introduction of the catheter are summarized.
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Critical care clinics · Oct 1992
ReviewCentral venous catheterization in the critically ill patient.
Central venous catheter placement for access and monitoring purposes is one of the most commonly performed procedures in the intensive care unit. This article details the indications, techniques, and advantages and disadvantages associated with various approaches to central line insertion; complications associated with central venous line insertion are also reviewed briefly.
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Arterial catheterization is used frequently in the management of critically ill patients, both for continuous blood pressure monitoring and access to the arterial circulation to obtain frequent blood gas measurements. The procedure is usually easily accomplished at the bedside using percutaneous methods such as the Seldinger technique to cannulate the radial, brachial, axillary, femoral, or dorsalis pedis artery. Meticulous attention to aseptic technique is necessary during insertion and catheter maintenance to minimize the risk of catheter-related infection. Other potential complications include hemorrhage, ischemia, arteriovenous fistula, and pseudoaneurysm formation.
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Critical care clinics · Oct 1992
ReviewSengstaken-Blakemore tube placement. Use of balloon tamponade to control bleeding varices.
The management of acute variceal bleeding continues to challenge those who care for patients with portal hypertension. Survival depends on rapid institution of an established protocol for resuscitation, diagnosis, and management of the patient. Balloon tamponade plays an important part in the management of this problem along with pharmacologic and endoscopic modalities. It is important in closing, however, to note that guidelines for use cannot compensate for lack of experience and the authors agree with Vlavianos and colleagues in stating that without experience in its use, balloon tamponade is of limited value.
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Endotracheal intubation can be accomplished by several different methods, which are discussed herein. Special considerations such as the obstructed tube, air leakage around the tube, tube replacement, and drug therapy are also reviewed, as are the indications for tracheostomy, the use of double lumen tubes, and fiberoptic laryngoscopy or bronchoscopy.