We would like to propose a technique using a 5-Fr micropuncture kit to obtain vascular access in critically ill patients who are at high risk for immediate procedural complications. The ability to obtain rapid vascular access, both arterial and venous, is a critical skill in emergency medicine [ 1 ]. Emergent vascular access may be challenging because of the patient’s body habitus, anatomical deformities, agitation or altered mental status, intravascular volume loss, and hemodynamic status. These unpredictable factors turn an otherwise routine procedure into a lengthy and complicated one that exposes the patient to multiple needle sticks and increases the rate of serious complications (e.g., pneumothorax, vascular and nerve injuries, hemorrhage, or hematoma formation) [ 2 , 3 ]. A major risk factor when several attempts are made at obtaining vascular access is the multiple posterior wall punctures with a large bore needle [ 4 ]. This may be mitigated by the use of a micropuncture kit ( Fig. 1).
Montrief T, Ramzy M, Long B. Micropuncture kits for difficult vascular access . Am J Emerg Med. 2020;S0735-6757(20)30655-0. doi:10.1016/j.ajem.2020.07.059