Large bore venous access above the diaphragm is essential in critically ill and cardiac arrest patients for fluid resuscitation. This type of access allows for the rapid administration of resuscitative fluids and blood products directly into the central circulation and heart, making it more efficient in emergency situations (Kirkpatrick, 2023). In cases of major intrathoracic hemorrhage or during cardiac surgery, having large bore intravenous access in place is crucial for prompt volume resuscitation (Caniglia-Miller et al., 2014). Additionally, in trauma scenarios, effective resuscitation can be challenging when venous access points are distal to the injury, emphasizing the importance of large bore venous access above the diaphragm (Willis et al., 2022).
Establishing large bore venous access enables the administration of critical medications and infusions needed during sudden cardiac arrest or shock states (Drozd et al., 2021). In situations like extracorporeal membrane oxygenation (ECMO) where large bore venous cannulas are utilized, having appropriate access is vital for the success of the procedure (Grouls et al., 2022). Furthermore, in cases of refractory shock during cardiac arrest, advanced large bore alternative access techniques are recommended (Cui et al., 2019).
In summary, large bore venous access above the diaphragm is indispensable in managing critically ill and cardiac arrest patients for fluid resuscitation. It allows for the rapid and efficient delivery of resuscitative fluids, blood products, and medications directly to the central circulation and heart, ensuring timely and effective treatment in emergency situations.
References:
- Caniglia-Miller, J., Bussey, W., Kamtz, N., Tsai, S., Erickson, C., Anderson, D., … & Moulton, M. (2014). Surgical management of major intrathoracic hemorrhage resulting from high-risk transvenous pacemaker/defibrillator lead extraction. Journal of Cardiac Surgery, 30(2), 149-153.
https://doi.org/10.1111/jocs.12500
- Cui, C., Cook, B., Cauchi, M., & Foerst, J. (2019). A case series: alternative access for refractory shock during cardiac arrest. European Heart Journal - Case Reports, 3(3).
https://doi.org/10.1093/ehjcr/ytz101
- Drozd, A., Smereka, J., Filipiak, K., Jaguszewski, M., Ladny, J., Bielski, K., … & Szarpak, L. (2021). Intraosseous versus intravenous access while wearing personal protective equipment: a meta-analysis in the era of covid-19. Kardiologia Polska, 79(3), 277-286.
https://doi.org/10.33963/kp.15741
- Grouls, A., Nwogu-Onyemkpa, E., Guffey, D., Chatterjee, S., Herlihy, J., & Naik, A. (2022). Palliative care impact on covid-19 patients requiring extracorporeal membrane oxygenation. Journal of Pain and Symptom Management, 64(4), e181-e187.
https://doi.org/10.1016/j.jpainsymman.2022.06.013
- Kirkpatrick, A. (2023). Comment on “moving the needle on time to resuscitation: an east prospective multicenter study of vascular access in hypotensive injured patients using trauma video review”. Journal of Trauma and Acute Care Surgery, 96(2), e16-e17.
https://doi.org/10.1097/ta.0000000000004127
- Willis, G., Robinson, J., Green, J., Dieffenbaugher, S., Madjarov, J., LeNoir, B., … & Cunningham, K. (2022). Atrial cannulation during resuscitative clamshell thoracotomy. The American Surgeon, 89(6), 2468-2475.
https://doi.org/10.1177/00031348221101479