A parturient with a history of extremely difficult intravenous access recently presented to our unit. She had previously required two category-3 caesarean sections, at 29 and 32 weeks of gestation, respectively, for severe early-onset preeclampsia. On both occasions, despite multiple attempts at siting both peripheral and central access by different consultant anaesthetists, surgical cut-down procedures were required to provide venous access before surgery. She was therefore referred to our High Risk Obstetric Anaesthetic Clinic for assessment at 16 weeks of gestation in her third pregnancy. At that stage she had one palpable vein in her right antecubital fossa and visible scarring on her other limbs from previous cut-downs. Although venous access was considered possible in an elective situation, potentially with radiological guidance or further cut-downs, the patient was obviously at risk if presenting as an emergency. Central access had previously not been possible and with only an obstetric ultrasound scanner available on the delivery suite in an acute situation, we were not confident that this would be a reliable option.
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Published online: June 06, 2011
Accepted: January 31, 2011
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.