Portal de Periódicos da CAPES

AAGBI safe vascular access guidelines - a reply

2016; Wiley; Volume: 71; Issue: 12 Linguagem: Inglês

10.1111/anae.13719

1365-2044

Andrew Bodenham,

Vascular Procedures and Complications

We thank Coe 1, Bierman 2 and Plummer and Lavinio 3 for their comments on the recent AAGBI safe vascular access guidelines 4, and reply as follows. We agree that there is limited evidence for pH being an important determinant for suitability for peripheral intravenous administration. We have adapted Table 1 in the document accordingly, and corrected the guidelines 6. There is no clear evidence about risk of death with different positioning of catheter tips. However, clinical experience and expert opinion suggests that placement of catheters in the low superior vena cava and upper right atrium positions is generally safe, and optimises catheter function in the longer term. We have not contacted the manufacturers about the length of vascular dilators, but raise it as an issue for operators to be aware of. The ideal length has not been determined, but the suggested 4 cm length may be too short for femoral or subclavian approaches in the larger patient. One option would be for it to be similar length or slightly longer than the standard 8 cm access needle. Inadvertent retention of central venous catheter guidewires has been publicised in the UK by categorisation as a so called ‘Never Event’ 5, which may encourage organisations to improve practices in this area. We agree that checklists may help in identifying and preventing errors at multiple stages of the procedure. We agree with the points Plummer and Lavinio raise about preventing stroke following inadvertent carotid artery catheterisation, but don't believe they contradict the guidance in this document. There is no accepted or published algorithm to follow, hence the lack of detail in this document. Each case will be different (e.g. the pre-existing vessel narrowing in the cited case) and local facilities and expertise will vary. The important issues are: to avoid the problem by routine effective use of ultrasound guidance; recognise it when it occurs; refer immediately; and seek early, safe removal of the device.