Resuscitative Vascular Access

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Multi-Lumen Access Catheter (MAC Line) Insertion

The anatomical properties of the subclavian vein provide a number of benefits for its use in central venous access, especially during trauma resuscitation. The subclavian vein is a large diameter central vein without valves which, as a result of its soft tissue attachments, remains patulous and undisplaced even in the hypovolaemic patient.

By comparison the Internal jugular vein (IJV) is less suitable during trauma resuscitation due to its collapsibility in hypovolaemia, and the need to remove cervical splinting and rotate a potentially injured cervical spine. The femoral route remains a viable alternative, its main drawbacks include increased rates of line infection (19.8%) and lower limb thrombosis (21.5%), which can be a particular problem in immobilised trauma patients who have increased rates of venous thromboembolism. The femoral vein also collapses with hypovolaemia, and may be inappropriate in patients with significant abdominal or pelvic trauma with concerns about downstream venous injury. Access to this vein may also be impeded by a pelvic binder.

Join us at The Procedures Course in Melbourne to practice this and other life and limb saving procedures.


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