Central venous catheterization


Central venous catheter or vascular access device is a long tube , thin and flexible , used for administering medicinal substances , fluids , nutrients or blood products for long periods , usually several weeks or more.
The catheter is inserted through the skin into a vein in the neck or chest . Is pushed through the vein until it reaches a vein near the heart.

Central venous catheters are used for:
– Long-term administration of treatments for pain, infection , cancer , or dietary supplements ;
– Central venous catheter can be maintained longer than a peripheral venous catheter through which medication is administered at the level of superficial veins ( under the skin )
– Medicinal products acting heart , especially if you want a quick
– To measure the pressure in the superior vena cava , which help diagnose heart conditions .

Types of central venous catheters
There are several types of central venous catheters .

A PICC ( peripheral insertion of a central catheter ) is a central venous catheter inserted into an arm vein to other types that are inserted into a vein in the neck or chest .

A tunneled catheter is surgically inserted into a vein in the neck or chest and is secured subcutaneously. Only the end of the catheter is brought to the skin surface to administer medication . Passing the catheter under the skin facilitates better fit his, makes it less restrictive and less visible .

An implant is similar hole tunneled catheter but is totally ordered under the skin. Drug substances are administered through the skin into the catheter . Some implants include a small tank that can be filled in the same manner . Once loaded , the reservoir slowly releases substances into the bloodstream . An implant is less visible hole and requires less care than a tunneled catheter . Influences the activity of a person less than a PICC or tunneled catheter .

Possible complications:
angerare caused by insertion of the catheter into the vein
collapsed lung ( alveolar walls adjoining the lungs caused by the flattening of pneumothorax )
risk of lung collapse depends on the ability of the person inserting the catheter and the anatomical region where is located , is more frequent insertion of the chest , although the risk is still small
infection requiring treatment with antibiotics or removal of the catheter
clogging or twisting ( torsion ) catheter , regular irrigation catheter blockage prevents the installation and torque is required if catheter repositioning
pain at the site of insertion of the catheter into the vein
movement of the catheter , a catheter can be repositioned traveled sometimes it is not possible to replace it with another.

Coronary bypass revascularization surgery is used to improve blood flow to the heart in patients with severe coronary artery disease .
Coronary artery diseases occur when the arteries that bring blood to the heart muscle (called coronary arteries ) become blocked due to obstruction of a material called plaque that forms inside the blood vessel . If the blockage is severe , there may be chest pain (also called angina ) , shortness of breath and , in some cases , myocardial infarction.
CABG is one treatment for these disorders . During this surgery , a healthy artery or vein is taken from another part of the body is diseased artery graft . Grafted artery or vein bypasses the blocked portion of the coronary artery . This new passage will bring oxygen-rich blood to the heart muscle . Can be replaced up to four during a coronary artery bypass surgery .
This is one of the most common open heart surgery performed in the world .
Physicians who are called cardiothoracic surgery done .
CABG can not be done any patient with diseased coronary arteries . Many people with these conditions can be treated by other means such as life style changes , medications, or other revascularization procedure called angioplasty.
CABG may be a treatment option if the patient has a severe blockage in a coronary artery that supplies blood big an important area of heart muscle – especially if the pumping action of the heart has already been affected.
May be an option and if coronary blockage can not be resolved by angioplasty bypass this situation is considered the most effective .
If the patient is a candidate for CABG , the goals of surgery are:
– Improved quality of life and decreased angina attack frequency and other symptoms of coronary heart disease,
– Resume a more active lifestyle ,
– Improving the pumping capacity of the heart if it was damaged by a heart attack,
– Reduced risk of myocardial infarction ( in some patients, such as those with diabetes
– Improving the chances of survival .

Repeat surgery may be necessary if grafted artery or vein becomes blocked, or if a new blockage develops in other arteries that were previously healthy .
Medication administration according to recipe and lifestyle changes can decrease the chances of blocking the artery graft. In patients who are candidates for this type of surgery , the results are usually excellent , 85 % had a significant reduction of symptoms, a lower risk for heart attack and subsequently decrease the risk of death within 10 years of surgery .

Types of CABG
Traditional CABG
This is the most common type of CABG . It is used when at least one of the coronary arteries needing bypass . During surgery , the chest is opened to access the heart. Are given drugs to stop the heartbeat, and heart-lung machine is used for artificial oxygenation of body tissues during surgery. This allows the surgeon to operate on a stopped heart . After surgery , the heart is restarted using low intensity electric shock .

The coronary bypass without pump
This is similar to the traditional one in that it is open the chest to access the heart. However , the heart is stopped and does not use artificial heart-lung machine . It operates while the heart continues to beat . This type of intervention can reduce the risk of complications when used artificial heart-lung machine and can make recovery from surgery to be faster .

Coronary bypass the minimally invasive
This operation is similar to the above, but in large incision to open the chest , several small incisions are made on the left side of the chest , between the ribs . The surgery is used mainly for the front of the arteries of the heart. It is a new procedure that is used less often than others. This type of surgery is not for all patients , especially if more than one or two coronary arteries need surgery.

Coronary artery bypass surgery
It is used to treat patients with severe coronary artery disease , which may lead to myocardial infarction . Your doctor may recommend bypass surgery if other treatments such as lifestyle changes or medications , have had the desired result. May recommend bypass and if the patient has blocked one of the large arteries which pump blood into an important area of heart – especially if the pumping force of the heart is low.
Bypass can be used if angioplasty coronary disease can not solve . The doctor will assess whether surgery , taking into account many factors: the presence and severity of coronary artery disease symptoms , severity and location of blockages in the coronary arteries , the response to other therapies, patient quality of life and other medical problems that you have it . In some cases, coronary bypass surgery can be performed in emergency , such as after a heart attack or type .

Physical examination and tests for diagnosis
To determine whether a patient is a candidate for CABG , your doctor will perform a physical examination that involves checking the cardiovascular system , focusing on the heart and lungs. The doctor will ask questions about the symptoms that the patient shows such fidurerea chest or shortness of breath, how long , how often they occur and how severe they are.

It performs tests to find out which roads are blocked, how are blocked and how he affected the heart . These tests include:
– ECG ( electrocardiogram ) . An ECG is a simple test that detects and records the electrical activity of the heart. This test is used to determine and locate the source of heart problems . An ECG shows how fast the heart beats , when the heart rate is regular or irregular , in the region of the heart ‘s electrical activity starts , and whether it traverseza heart normal way .
– Stress test . Some heart problems are easier to diagnose when the heart is beating faster and sustained activity than at rest . During the stress test the patient performs a physical activity ( those who can not be given a medication ) for the heart to work harder and beat faster while achieving testului.Se recorded ECG , blood pressure, while the patient goes or running on a treadmill or pedaling a bicycle.
Other heart tests , such as imaging with radioactive isotopes or echocardiogram can be performed simultaneously. They will be recommended if your doctor needs more detailed information about blood flow and the heart’s ability to pump blood , than can provide stress test .
If the patient can not exercise, a medicine can be injected intravenously to make the heart beat stronger and faster , as the patient would make the treadmill or exercise bike.
If the radio imaging , a radioactive isotope is injected into the blood, and with the help of a special device can see the flow of blood through the heart and arteries.
Echocardiography uses sound waves to show blood flow through the chambers and valves of the heart and to show how well the heart is beating .
Your doctor may recommend other two tests that can be done during the stress test , if needs more detailed information about the activity of the heart . The two new tests are magnetic resonance imaging ( MRI) and Positron Emission Tomography (PET). MRI shows detailed images of the structure and the way the heart beats , which helps the doctor to better assess which parts of the heart are damaged . This test can help your doctor determine whether blood flow through arteries coronarieine enough. A PET test may show decreased blood flow caused by disease or damaged muscles that may not be identified by other diagnostic methods .
– Echocardiogram . This test uses sound waves to create a moving picture of the heart. Echocardiogram provides information about the shape and big heart , and how well the heart chambers and valves . The test can also identify a weak blood flow , areas of the heart that are not contracting normally , and previous injury of the heart muscle blood flow caused by Rosin . There are several different types of echocardiograms , including stress echocardiogram . During this test , a ecocardiogarama is realized both before and after the patient receives a drug or do exercises on the treadmill or bike.
Stress echocardiogram is usually done to identify dysfunction of the heart pumping .
– Angiography . Angiography uses a special ink that is injected into the bloodstream and help to look inside the arteries in radiography . An angiogram will show the precise location and severity of blockages in the arteries .

To decide whether a patient is a candidate for CABG , your doctor will take into account the following :
• medical history and treatment administered for heart disease , including surgeries , surgery or drugs
• history of other diseases and conditions ,
• age and general health ,
• personal history of coronary heart disease , heart attack or other cardiac disease .
Before deciding surgery will try drugs and other procedures. For most of the drugs are often used to lower cholesterol, and antihypertensive drugs that improve blood flow through the coronary arteries.

A procedure called coronary angioplasty (also called balloon angioplasty ) can be tried .
During this phase, a thin tube with a balloon or other device on the end is inserted into the blood vessels in the groin or arm and pushed to the narrowed or blocked coronary artery . Once in place narrowing , the balloon is inflated to push the plaque Peter the arterial wall , increasing the lumen of the artery and allowing blood flow to flow to the heart . In many cases , after initial angioplasty a small tube called a stent is inserted permanently in the area to keep the artery open .

description of intervention
Before the surgery itself can be done tests to prepare for bypass surgery , including blood tests , ECG, echocardiogram , chest x-ray , cardiac catheterization and angiography.
Your doctor will give you specific instructions to prepare the patient for surgery. There will be instructions on how and when to eat and drink , what medicines to take and what activities to interrupt (such as smoking ) .
Coronary bypass surgery requires a team of experts . A cardiothoracic surgeon will perform the surgery with an anesthesiologist , perfuzionist ( specialist in the use of heart-lung apratului artificial ) , other surgeons and nurses .
There are many different types of CABG . From traditional type in which the chest is opened for heart approach to nontraditional methods in which small incisions are made only approach .
Traditional CABG surgery
This type of surgery usually takes between 3 and 5 hours depending on the number of roads that should be made. There are several steps to follow during this procedure . Anesthesia is made ​​for the patient to sleep and not feel pain . During surgery , the anesthesiologist monitors your heartbeat , blood pressure, blood oxygen levels and breathing . A breathing tube is inserted into the lungs through the larynx and trachea and connected to a ventilator. The incision is made in the middle of the chest . Then sternum is cut and the rib cage is opened so that the surgeon can reach the heart . Drugs are used to stop the heart , which allows the surgeon to operate on a heart that beats . A device which is called artificial heart-lung keeps oxygen-rich blood flow within the body. An artery or vein is taken from another part of the body such as the chest or leg , and is ready to be used to bypass .

In operation the bypass are several sites , typically using a combination of arteries and veins.
– Arterial grafts . This type of graft has a lower risk of becoming blocked later in life. Left internal mammary artery is most commonly used as a graft. It is located inside the chest , near the heart . Sometimes it can be used also other arteries harvested from arm or other body parts.
– Vein grafts . Although veins are often used as grafts , they have a higher risk of developing plaque and is obstructed while . Saphenous vein – a vein that lies long on the inner side of the lower leg – is usually used .
When surgery is completed , the heart will be started with low intensity electrical shocks . The patient is disconnected from the heart-lung machine and inserted inside the chest drainage tubes to collect fluid will be formed after the closing of the thorax. The surgeon will use stitches that will remain permanently in the patient’s body to close the chest and thinner wire staples or sutures to the skin. Intubation tube is removed when the patient is able to breathe on his own .
Include nontraditional CABG without bypass heart-lung machine and minimally invasive bypass
CABG without heart-lung machine This type of intervention can be used to bypass any coronary artery . In this type of heart surgery is not stopped and the heart-lung machine is not used . Instead, the heart will be operated is held in place by a mechanical device.
This type of intervention can reduce the risk of complications that can occur when using an artificial heart-lung machine , especially in patients who have had a previous heart attack or minor stroke , in patients older than 70 years at the with diabetes, lung or kidney .
Other advantages of this type of intervention are :
– Reduce bleeding during surgery and reduces the risk of use of blood transfusion ,
– Lowers the risk of infection, stroke or kidney disease
– Decreases the risk of complications such as memory loss, difficulty concentrating attention and difficulty to think clearly ,
– Hastens postoperative recovery .

CABG using minimally invasive techniques There are several types of minimally invasive CABG . They differ from traditional type because it requires only small incisions and the opening of the chest to reach the heart . These techniques sometimes use heart-lung machine .
Direct technique . This technique is used only when one or two arteries be made. A series of small incisions are made ​​between the ribs on the left side of the chest , directly over the artery to be operated . Incisions usually have a length of about 7.5 cm ( incision in traditional surgery is 15-20 cm long). The left internal mammary artery is frequently used as a graft. Heart-lung machine is not used in this procedure .
By port – access procedure . This procedure is performed through small incisions ( ports) made ​​in the chest . Use artery or vein grafts . Heart-lung machine is used during this operation .
Robotics . This type of procedure is performed through very small incisions . A small view camera is inserted through one of the incisions to view the heart , while the surgeon uses remotely controlled surgical instruments to perform the surgery . Decord -lung machine is sometimes used when accessed techniques . The advantages of minimally invasive techniques are smaller incisions , smaller scars , faster recovery , shorter hospital stay , less bleeding , fewer infectious complications and less pain .

After surgery , the patient will spend one or two days in the intensive care unit . Will be continuously monitored heart rate and blood pressure during this time . Usually given intravenous medication to regulate blood flow and blood pressure. Then the patient will be moved to another section of the hospital for 3-5 days before being released.
Recovering at home
The doctor will give the patient specific instructions to recover at home:
– How to care for incisions to heal without complications ,
– How to recognize the symptoms of infection or other complications ,
– When to seek medical help urgently ,
– When to schedule the inspection .

The patient will receive instructions on how to cope with the adverse effects of surgery. These effects may disappear in 4-6 weeks after surgery and may include:
– Discomfort or itching at the incision site ,
– Swelling of the area that was harvested vein or artery was used for grafting ,
– Muscle pain or squeezing sensation in the shoulders or upper back or
– Tiredness mood swings or depression
– Difficulty falling asleep or loss of appetite ,
– constipation
– Chest pain around the incision (more frequent with traditional surgery ) .

Recovery after bypass traditional Competa is done in 6 to 12 weeks or more. A short recovery time is necessary when using nontraditional techniques .
The doctor will give you instructions and in terms of resuming physical activity. This varies depending on the patient , but there are some time limits. Most patients can resume their physical activity after 4 weeks and driving after 3 to 6 weeks.
Resumption of service is usually done after 6 weeks , except in the service involves intense physical activity . Some patients need to find services that involve less physical effort and have to start a program soon .
Continuing care after surgery can include repeated medical examinations . During these inspections may be performed various tests to see how the heart works . Tests can be ECG , stress testing and echocardiography .
CABG does not cure coronary artery disease . Doctor and his patient should jointly develop a care plan that includes lifestyle changes that you can help the patient to stay healthy and reduce the risk of coronary artery disease . Changes in lifestyle can include smoking cessation, dietary changes, perform regular exercise, lowering stress and its management . In some cases the patient may be referred to a cardiac rehabilitation program . These programs aim to recover through supervised physical activity and education on how to reduce the risk for future heart disease and helps the patient to resume lifestyle before surgery.
Doctors oversees such programs include counseling for lifestyle modification and exercise to increase strength and energy. Administration of prescribed medication is also an important step in the care after surgery. Medications may be prescribed to control pain during recovery , to lower cholesterol or blood pressure , prevent blood clots , to control diabetes or depression .

risks of surgery
Although the occurrence of complications after coronary bypass is unlikely , risks can be related to:
– Bleeding or wound infection ,
– Reactions to anesthesia ,
– Fever ,
– Pain ,
– Stroke, myocardial infarction or death .
Some patients may develop fever chest pain , irritability and loss of appetite . They are due to inflammation that can affect lung or pericardium may occur in 1 to 6 WEEKLY after surgery because it involved cutting the pericardium . This condition is mild , self-limited , but there are patients who may develop fluid in the pericardium that requires treatment.
Artificial heart lung machine use may also cause complications : loss of memory or other modifiari such as difficulty concentrating or thinking clearly of attention . These changes usually occur in older patients who have hypertension or pulmonary disease , or who are chronic alcohol consumption . These side effects often improve on these catreva months after surgery.
Heart-lung machine also increases the risk of blood clots in blood vessels . These clots can reach the brain or other parts of the body , blocking blood flow and causing heart attack or other problems.
In general, the risk of complications is higher when bypass surgery is performed in emergency ( for example , when it is performed during a heart attack ) , if the patient is aged over 70 years and if you have a history of smoking . The risk is greater in patients who have other diseases such as diabetes, kidney or lung disease or peripheral circulation .
key Points
– Coronary bypass surgery is a type of surgery used to improve blood flow to the heart in people with severe coronary artery disease ,
– During surgery, a healthy artery or vein harvested from another part of the body is grafted coronary artery affected blood flow can bypass the blocked. This detour will result in improved heart muscle vasculature ,
– CABG is a type of intervention for severe coronary artery disease .
Not all patients require bypass coronary heart disease . In patients who are candidates for this surgery , the results are usually excellent , 85 % of them having a significant reduction in symptoms , less risk for a future heart attack, and less chance of death within 10 years after surgery.
– The doctor is the one who decides which patients are candidates for this surgery. It will first try other interventions such as drugs or angioplasty .
– Although surgery is usually done with programming , there are situations in which it is done in emergency , such as during a heart attack
– Although complications are rare , there is the risk of bleeding or wound infection , reaction to anesthesia , pain or fever , heart attack or stroke or sudden death.
– Postoperative recovery is done in 6-12 weeks or more. Most patients resume their normal activities 6 weeks after surgery.
– Care after surgery may include periodic health checks , lifestyle changes for the prevention of coronary disease worsening and prescription medication administration .


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