Vascular Access
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Vascular Access
Vascular access refers to a rapid, direct method of introducing or removing devices or chemicals from the bloodstream. In hemodialysis, vascular access is used to remove the patient's blood so that it can be filtered through the dialyzer. Three primary methods are used to gain access to the blood: an intravenous catheter, an arteriovenous fistula (AV) or a synthetic graft. In the latter two, needles are used to puncture the graft or fistula each time dialysis is performed. The type of vascular access created for patients on hemodialysis is influenced by factors such as the expected time course of a patient's kidney failure and the condition of his or her vasculature. Patients may have multiple accesses, usually because an AV fistula or graft is maturing and a catheter is still being used. The creation of all these three major types of vascular accesses requires surgery. Catheter Catheter access, sometimes called a CVC (central venous catheter), consists of a plastic catheter wit ...
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Circulatory System
The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, that consists of the heart and blood vessels (from Greek ''kardia'' meaning ''heart'', and from Latin ''vascula'' meaning ''vessels''). The circulatory system has two divisions, a systemic circulation or circuit, and a pulmonary circulation or circuit. Some sources use the terms ''cardiovascular system'' and ''vascular system'' interchangeably with the ''circulatory system''. The network of blood vessels are the great vessels of the heart including large elastic arteries, and large veins; other arteries, smaller arterioles, capillaries that join with venules (small veins), and other veins. The Closed circulatory system, circulatory system is closed in vertebrates, which means that the blood never leaves the network of blood vessels. Some in ...
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Fistula
A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow organs. Types of fistula can be described by their location. Anal fistulas connect between the anal canal and the perianal skin. Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a vesicouterine fistula, between the bladder and the vagina in a vesicovaginal fistula, and between the urethra and the vagina in urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intest ...
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Thrombosis
Thrombosis (from Ancient Greek "clotting") is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (thrombocytes) and fibrin to form a blood clot to prevent blood loss. Even when a blood vessel is not injured, blood clots may form in the body under certain conditions. A clot, or a piece of the clot, that breaks free and begins to travel around the body is known as an embolus. Thrombosis may occur in veins (venous thrombosis) or in arteries (arterial thrombosis). Venous thrombosis (sometimes called DVT, deep vein thrombosis) leads to a blood clot in the affected part of the body, while arterial thrombosis (and, rarely, severe venous thrombosis) affects the blood supply and leads to damage of the tissue supplied by that artery (ischemia and necrosis). A piece of either an arterial or a venous thrombus can break off as an embolus, which could ...
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Brachial Artery
The brachial artery is the major blood vessel of the (upper) arm. It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries which run down the forearm. In some individuals, the bifurcation occurs much earlier and the ulnar and radial arteries extend through the upper arm. The pulse of the brachial artery is palpable on the anterior aspect of the elbow, medial to the tendon of the biceps, and, with the use of a stethoscope and sphygmomanometer (blood pressure cuff), often used to measure the blood pressure. The brachial artery is closely related to the median nerve; in proximal regions, the median nerve is immediately lateral to the brachial artery. Distally, the median nerve crosses the medial side of the brachial artery and lies anterior to the elbow joint. Structure The brachial artery give ...
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Cephalic Vein
In human anatomy, the cephalic vein is a superficial vein in the arm. It originates from the radial end of the dorsal venous network of hand, and ascends along the radial (lateral) side of the arm before emptying into the axillary vein. At the elbow, it communicates with the basilic vein via the median cubital vein. Anatomy The cephalic vein is situated within the superficial fascia along the anterolateral surface of the biceps. Origin The cephalic vein forms over the anatomical snuffbox at the radial end of the dorsal venous network of hand. Course and relations From its origin, it ascends ascends up the lateral aspect of the radius. Near the shoulder, the cephalic vein passes between the deltoid and pectoralis major muscles (deltopectoral groove) and through the clavipectoral triangle, where it empties into the axillary vein. Anastomoses It communicates with the basilic vein via the median cubital vein at the elbow. Clinical significance The cephalic vein ...
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Radial Artery
In human anatomy, the radial artery is the main artery of the lateral aspect of the forearm. Structure The radial artery arises from the bifurcation of the brachial artery in the antecubital fossa. It runs distally on the anterior part of the forearm. There, it serves as a landmark for the division between the anterior compartment of the forearm, anterior and posterior compartment of the forearm, posterior compartments of the forearm, with the posterior compartment beginning just lateral to the artery. The artery winds laterally around the wrist, passing through the anatomical snuff box and between the heads of the first dorsal interossei of the hand, dorsal interosseous muscle. It passes anteriorly between the heads of the adductor pollicis, and becomes the deep palmar arch, which joins with the deep branch of the ulnar artery. Along its course, it is accompanied by a similarly named vein, the radial vein. Branches The named branches of the radial artery may be divided into ...
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Cimino Fistula
A Cimino fistula, also Cimino-Brescia fistula, surgically created arteriovenous fistula and (less precisely) arteriovenous fistula (often abbreviated AV fistula or AVF), is a type of vascular access for hemodialysis. It is typically a surgically created connection between an artery and a vein in the arm, although there have been acquired arteriovenous fistulas which do not in fact demonstrate connection to an artery. Structure The radiocephalic arteriovenous fistula (RC-AVF) is a shortcut created between cephalic vein and radial artery at the wrist. It is the recommended first choice for hemodialysis access. However, after a period of usage, failures can occur. Possible causes for failure are stenosis and thrombosis especially in diabetics and those with low blood flow such as due to narrow vessels, arteriosclerosis and advanced age. Reported patency of fistulae after 1 year is about 60%, when primary failures were included. Juxa-anastomotic site (venous segment that is between ...
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Snuffbox
A decorative box is a form of packaging that is generally more than just functional, but also intended to be decorative and artistic. Many such boxes are used for promotional packaging, both commercially and privately. Historical objects are usually called caskets if larger than a few inches in more than one dimension, with only smaller ones called boxes. Gift box Traditionally gift boxes used for promotional and seasonal gifts are made from sturdy paperboard or corrugated fiberboard. These boxes normally consist of a base and detachable lid and are made by using a die cutting process to cut the board. The box is then covered with decorative paper. Gift boxes can be dressed with other gift packaging material, such as decorative ribbons and gift tissue paper. Work box The most common type of decorative box is the feminine work box. It is usually fitted with a tray divided into many small compartments for needles, reels of silk and cotton, and other necessaries for stitchery. ...
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Bruit
Bruit, also called vascular murmur, is the abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction or a localized high rate of blood flow through an unobstructed artery. The bruit may be heard (" auscultated") by securely placing the head of a stethoscope to the skin over the turbulent flow, and listening. Most bruits occur only in systole, so the bruit is intermittent and its frequency dependent on the heart rate. Anything increasing the blood flow velocity such as fever, anemia, hyperthyroidism, or physical exertion, can increase the amplitude of the bruit. Etymology It is naturalized from the French word for "noise", although another notes that and are also common, and others give only for the cardiac sense. Associated terms Describing location of a partial obstruction * Peripheral vascular disease; femoral artery stenosis * Renal artery stenosis * Stroke, carotid artery stenosis * Aortic aneurysm * Tinnitus – a sym ...
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Stethoscope
The stethoscope is a medical device for auscultation, or listening to internal sounds of an animal or human body. It typically has a small disc-shaped resonator that is placed against the skin, and one or two tubes connected to two earpieces. A stethoscope can be used to listen to the sounds made by the heart, lungs or intestines, as well as blood flow in arteries and veins. In combination with a manual sphygmomanometer, it is commonly used when measuring blood pressure. Less commonly, "mechanic's stethoscopes", equipped with rod shaped chestpieces, are used to listen to internal sounds made by machines (for example, sounds and vibrations emitted by worn ball bearings), such as diagnosing a malfunctioning automobile engine by listening to the sounds of its internal parts. Stethoscopes can also be used to check scientific vacuum chambers for leaks and for various other small-scale acoustic monitoring tasks. A stethoscope that intensifies auscultatory sounds is called a phonen ...
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Capillaries
A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter. Capillaries are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the smallest blood vessels in the body: they convey blood between the arterioles and venules. These microvessels are the site of exchange of many substances with the interstitial fluid surrounding them. Substances which cross capillaries include water, oxygen, carbon dioxide, urea, glucose, uric acid, lactic acid and creatinine. Lymph capillaries connect with larger lymph vessels to drain lymphatic fluid collected in the microcirculation. During early embryonic development, new capillaries are formed through vasculogenesis, the process of blood vessel formation that occurs through a '' de novo'' production of endothelial cells that then form vascular tubes. The term ''angiogenesis'' denotes the formation of new capillaries from pre-existing blood vessels and already present endo ...
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Anastomosis
An anastomosis (, plural anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf#Veins, leaf veins, or streams. Such a connection may be normal (such as the foramen ovale (heart), foramen ovale in a fetus's heart) or abnormal (such as the atrial septal defect#Patent foramen ovale, patent foramen ovale in an adult's heart); it may be acquired (such as an arteriovenous fistula) or innate (such as the arteriovenous shunt of a metarteriole); and it may be natural (such as the aforementioned examples) or artificial (such as a surgical anastomosis). The reestablishment of an anastomosis that had become blocked is called a reanastomosis. Anastomoses that are abnormal, whether congenital disorder, congenital or acquired, are often called fistulas. The term is used in medicine, biology, mycology, geology, and geography. Etymology Anastomosis: medical or Modern Latin, from Gre ...
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