Document 0154
 DOCN  M9460154
 TI    A new percutaneous technique for establishing venous bypass access in
       orthotopic liver transplantation.
 DT    9408
 AU    Oken AC; Frank SM; Merritt WT; Fair J; Klein A; Burdick J; Thompson S;
       Beattie C; Department of Anesthesiology, Johns Hopkins Hospital,
       Baltimore,; MD 21205.
 SO    J Cardiothorac Vasc Anesth. 1994 Feb;8(1):58-60. Unique Identifier :
       AIDSLINE MED/94220635
 AB    Partial veno-venous bypass (VVB) is commonly used in orthotopic liver
       transplantation (OLT). Venous access for blood return during VVB
       classically uses a surgical cutdown on the left axillary vein (LAV),
       which may prolong operating time and can be associated with significant
       complications. The authors have developed an alternative means of
       establishing venous access whereby the anesthesia team places 8.5F
       venous cannulae preoperatively in one or two vessels (internal jugular,
       antecubital, or subclavian) percutaneously using the Seldinger
       technique. These cannulae then serve to accept venous return from below
       the diaphragm via a centrifugal pump. The aim fo the present study was
       to compare the hemodynamic profiles obtained during the anhepatic phase
       of OLT in patients in whom either a conventional LAV catheter (group 1)
       or percutaneous catheters (group 2) were used for return flow from a
       centrifugal pump. There were no identifiable complications related to
       venous access in either group of patients. Total operating room time was
       800 +/- 30 minutes in group 1 and 720 +/- 40 minutes in group 2 (P =
       0.17). Hemodynamic parameters were determined from continuous strip
       chart recordings of arterial, right atrial, and inferior vena caval
       (IVCP) pressures. Cardiac output (CO) was measured by thermodilution
       whereas pump flow was determined by an electromagnetic probe. Renal
       perfusion pressure (RPP) was calculated as the difference between mean
       arterial pressure (MAP) and IVCP. Bypass pump flow was greater, but not
       significantly different between group 1 (3.0 +/- 0.2 L/min) and group 2
       (2.4 +/- 0.2 L/min) (P = 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)
 DE    Axillary Vein/SURGERY  Blood Pressure  Blood Transfusion  Cardiac Output
       Catheterization, Central Venous  *Catheters, Indwelling  Central Venous
       Pressure  Comparative Study  Elbow/BLOOD SUPPLY  Femoral Vein/SURGERY
       Heart Rate  Hepatic Artery/SURGERY  Human  Jugular Veins/SURGERY  *Liver
       Transplantation  Oxygenators  Portal Vein/SURGERY  Subclavian
       Vein/SURGERY  Time Factors  Veins/SURGERY  Vena Cava, Inferior/SURGERY
       *Venous Cutdown  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).