Vascular access

Abstract

Access to the central vascular system is being employed increasingly in modern management and is required in a wide variety of clinical disciplines such as intensive care, surgery, medicine, nephrology, oncology and so on. The indications for its use are ever expanding. Arteriovenous shunts and fistulae are conventionally used for haemodialysis and obviously serve as an excellent means of access for nutrition, when required. However, they are rarely, if ever, used in the vast majority of medical and surgical patients without renal failure who require nutritional support. This discussion will therefore concentrate on central venous access for purposes of nutrition. As discussed in previous chapters peripheral feeding is only applicable in a few selected situations (e.g. elective surgery) and access may be obtained in the normal way.