Transvascular access methods
Various methods employing transvascular access devices are described, including a method of placing a central catheter in a peripheral vein in an arm of a patient; a method of providing percutaneous access to the heart of a patient; a method of clearing a clotted arteriovenous dialysis graft; a method of creating multiple access points into a single blood vessel; a method of creating an AV fistula in a patient; and a method of providing a bypass to a blockage in a popliteal artery in a patient.
1. A method of placing a central catheter in a peripheral vein in an arm of a patient, the method comprising:
inserting an access device percutaneously through an entry site in a femoral vein of the patient, the access device comprising a vascular catheter;
advancing a distal end of the vascular catheter from the entry site to an exit site in the peripheral vein;
advancing a puncture tool from the distal end of the vascular catheter through the peripheral vein wall and skin of the patient at the exit site;
after the step of advancing the puncture tool, inserting the central catheter into the peripheral vein at the exit site; and
inserting a micropuncture catheter into the peripheral vein at the exit site.
2. The method of claim 1 , wherein the peripheral vein comprises a cephalic vein.
3. The method of claim 1 , wherein the peripheral vein comprises a basilic vein.
4. The method of claim 1 , wherein the peripheral vein comprises a brachial vein.
5. The method of claim 1 , wherein the puncture tool comprises a sharp stylet.
6. The method of claim 1 , wherein the puncture tool comprises a needle-tipped guidewire.
7. The method of claim 1 , wherein the inserting the micropuncture catheter into the peripheral vein, comprises advancing the micropuncture catheter over the puncture tool into the peripheral vein.
8. The method of claim 1 , further comprising inserting a guidewire into the peripheral vein through the micropuncture catheter.
9. The method of claim 8 , further comprising advancing the central catheter over the guidewire into the peripheral vein.
10. The method of claim 1 , further comprising advancing the puncture tool from inside the peripheral vein to outside the peripheral vein.
11. The method of claim 1 , wherein the exit site comprises a central catheter entry point.
12. A method of placing a peripherally inserted central catheter in a peripheral vein in an arm of a patient, the method comprising:
inserting an access device percutaneously through an entry site in a femoral vein of the patient, the access device comprising a vascular catheter;
advancing a distal end of the vascular catheter from the entry site to an exit site in the peripheral vein;
advancing a puncture tool from the distal end of the vascular catheter through the peripheral vein wall and skin of the patient at the exit site;
advancing a micropuncture catheter over the puncture tool into the peripheral vein;
inserting a guidewire into the peripheral vein through the micropuncture catheter; and
inserting the central catheter into the peripheral vein over the guidewire.
13. The method of claim 12 , wherein the peripheral vein comprises a cephalic vein.
14. The method of claim 12 , wherein the peripheral vein comprises a basilic vein.
15. The method of claim 12 , wherein the peripheral vein comprises a brachial vein.
16. The method of claim 12 , wherein the puncture tool comprises a sharp stylet.
17. The method of claim 12 , wherein the puncture tool comprises a needle-tipped guidewire.
18. The method of claim 12 , further comprising advancing the puncture tool from inside the peripheral vein to outside the peripheral vein.
19. The method of claim 12 , wherein the exit site comprises a central catheter entry point.