Venous access

If exchange is to be performed via peripheral veins, one large antecubital vein is required sufficient to tolerate cannulation by a 16G butterfly needle as the drawing line (return line need only be 18G). If not possible, make arrangements for insertion of a central line prior to the planned exchanges inserting a double lumen renal dialysis type catheter of 16G or larger. Regular medication due immediately prior to exchange may be best deferred until immediately post-exchange particularly for drugs which are predominantly protein bound (see facing page).

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