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This makes blood sampling from the renal vein difficult.
The head-down position is a manoeuvre associated with that of sterile drapes when particular conditions (big and short neck, hypovolemia) make the cannulation of the jugular vein difficult [ 1].
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The main indication to the procedure was the urgent need of a peripheral venous access in patients with superficial veins difficult to palpate and/or visualize.
Firstly, pregnant women often present with conditions that make visualisation of the veins difficult, such as leg oedema or a gravid uterus, and that interfere with the visualisation of the proximal veins.
Generally, this vein is difficult to identify via median sternotomy because the heart blocks it from view.
Cannulating the femoral vein is difficult in more than 50% of patients after previous cardiac catheterization, and therefore the contralateral side should be used in the first attempt in such patients [ 36].
When introduction of the GTF from the internal jugular vein was difficult or impossible and insertion from the femoral vein had to be avoided because of the existence of a DVT on the approach route, the right subclavian vein was used.
If the vein is difficult to see, consider tying the tourniquet over the patient's shoulder to help squeeze blood into the arm.
If the vein is difficult to find, other routes like sublingual (placing the tablet below the tongue) or per rectal (inserting tablet through the anal opening) may also be used.
Multiple renal veins are difficult to visualize at US and limit the usefulness of US in diagnosing and excluding renal vein thrombus.
Ultrasound guidance is a useful tool for obtaining a peripheral intravenous access in the emergency department, particularly when superficial veins are difficult to identify by palpation and direct visualization, though standard peripheral intravenous cannulas are not ideal for this technique of insertion and may have limited duration.
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