Vascular Access: From Cannulation to Decannulation

Vascular access is one of the common procedures performed across the clinical setup. The most performed vascular access is the insertion of a peripheral cannula, the insertion of the central line, and arterial lines are more specialised procedures and required specialised training. Peripheral cannula insertion requires knowledge of basic vascular anatomy, location of the vein with or without ultrasound, type of cannula, use of local anaesthesia, and insertion procedure. The peripheral cannula must be kept patent and without any complication. Central venous lines and arterial line insertions are done by the Seldinger technique. To insert a central venous line the operator should have adequate training, knowledge of the central venous system. Use of ultrasound for the insertion is standard of care as it reduces the rate of complications when compared to the landmark technique. Insertion of the arterial has specific indications such as frequent arterial gas analysis, continuous blood pressure, or advanced hemodynamic monitoring. For the successful cannulation of an artery, the knowledge of anatomy and the use of ultrasound are the cornerstones. In the following text of the chapter, all the above-mentioned procedures are described in detail.