Vascular Access

Abstract

Vascular access is very important in modern medicine in general and in the care of sick children in particular (Coran 1992; Gauderer 1992). Some children are very dependent on long-term vascular access, for example, in the case of hemodialysis for endstage renal disease, total parenteral nutrition for short bowel syndrome, and ventriculoatrial shunting. When the classical access sites have become exhausted, vascular access becomes a major problem. Procedures such as lumbar venous access to the inferior vena cava through a lumbotomy (Boddie 1989), access of the vena azygos through a thoracotomy (Malt and Kempster 1983; Redo et al. 1992), and direct right atrial cannulation after sternotomy (Hayden et al. 1981) have been described, but such procedures are very invasive, and there is a continuous search to make these procedures less invasive. Percutaneous ultrasound-guided catherization of the inferior vena cava either through the lumbar region or though the liver is an example of this (Azizkhan et al. 1992; Robertson et al. 1990). Another possibility is to cannulate the azygos vein by percutaneous punction under thoracoscopic vision (Bax and van der Zee 1996).