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    Central Venous Catheterization

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    drhiwaomer
    This document provides guidance on central venous catheterization procedures. It describes the internal jugular and subclavian approaches. For the internal jugular approach, the catheter should be placed at the upper confluence of the sternocleidomastoid muscle at the level of the cricoid cartilage. The procedure involves locating the vein with a scout needle, inserting a catheter-over-needle, advancing a guidewire, and suturing the catheter in place. For the subclavian approach, the needle is inserted at the medial 1/3 of the clavicle and advanced until entering the vein. A guidewire and catheter are then inserted. A chest x-ray is needed post-procedure to confirm catheter placement and

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    Central Venous Catheterization

    Uploaded by

    drhiwaomer
    1K views20 pages
    This document provides guidance on central venous catheterization procedures. It describes the internal jugular and subclavian approaches. For the internal jugular approach, the catheter should be placed at the upper confluence of the sternocleidomastoid muscle at the level of the cricoid cartilage. The procedure involves locating the vein with a scout needle, inserting a catheter-over-needle, advancing a guidewire, and suturing the catheter in place. For the subclavian approach, the needle is inserted at the medial 1/3 of the clavicle and advanced until entering the vein. A guidewire and catheter are then inserted. A chest x-ray is needed post-procedure to confirm catheter placement and

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    surgical lecture

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    This document provides guidance on central venous catheterization procedures. It describes the internal jugular and subclavian approaches. For the internal jugular approach, the catheter should be placed at the upper confluence of the sternocleidomastoid muscle at the level of the cricoid cartilage. The procedure involves locating the vein with a scout needle, inserting a catheter-over-needle, advancing a guidewire, and suturing the catheter in place. For the subclavian approach, the needle is inserted at the medial 1/3 of the clavicle and advanced until entering the vein. A guidewire and catheter are then inserted. A chest x-ray is needed post-procedure to confirm catheter placement and

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT or read online from Scribd
    Download as ppt
    1K views20 pages

    Central Venous Catheterization

    Uploaded by

    drhiwaomer
    This document provides guidance on central venous catheterization procedures. It describes the internal jugular and subclavian approaches. For the internal jugular approach, the catheter should be placed at the upper confluence of the sternocleidomastoid muscle at the level of the cricoid cartilage. The procedure involves locating the vein with a scout needle, inserting a catheter-over-needle, advancing a guidewire, and suturing the catheter in place. For the subclavian approach, the needle is inserted at the medial 1/3 of the clavicle and advanced until entering the vein. A guidewire and catheter are then inserted. A chest x-ray is needed post-procedure to confirm catheter placement and

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT or read online from Scribd
    Download as ppt
    of 20

    Central Venous

    Catheterization

    Dr. Hiwa Omer Ahmed


    Assistant Professor
    Indications for central venous
    catheter cannulation:
    Monitoring of central venous pressures in
    shock or heart failure.
    management of fluid status.
    administration of total parenteral nutrition.
    prolonged antimicrobial therapy or
    chemotherapy
    Location of catheterization site

    A. The internal jugular approach should


    not be used in patients with a carotid bruit,
    carotid stenosis, or an aneurysm.
    B. The subclavian approach should be
    avoided in patients with emphysema or
    bullae.
    C. The external jugular or internal jugular
    approach by direct cut-down may be
    preferable in patients with coagulopathy or
    thrombocytopenia.
    D. If a chest tube already in place, the
    catheter should be placed on the same
    side as the chest tube
    Internal jugular vein cannulation
    The internal jugular vein is positioned
    behind the sternocleidomastoid
    muscle, lateral to the carotid artery
    The catheter should be placed at a
    location at the upper confluence of the two
    bellies of sternocleidomastoid at the level
    of cricoid cartilage.
    Procedure
    A. Place the patient in Trendelenburg's position,
    and turn the patient's head to the contralateral
    side. Choose a location on the right or left. If
    lung function is symmetrical and no chest tubes
    are in place, the right side is preferred because
    of the direct path to the superior vena cava.
    Prepare the skin with Betadine solution using
    sterile technique and drape the area. Infiltrate
    the skin and deeper tissues with 1% lidocaine
    B. Palpate the carotid artery. Using a 22-
    gauge scout needle and syringe, direct the
    needle toward the ipsilateral nipple at a 30
    degree angle to the neck. While
    aspirating, advance the needle until the
    vein is located and blood back flows into
    the syringe
    C. Remove the scout needle and advance an
    18gauge,
    thin wall, catheter-over-needle (with an attached
    syringe) along the same path as the scout
    needle. When back flow of blood is noted into
    the syringe, advance the catheter into the vein.
    Remove the needle and confirm back flow of
    blood through the catheter and into the syringe.
    Remove the syringe and cover the catheter hub
    with a finger to prevent air embolization
    D. With the catheter in position, advance a
    guidewire through the catheter. The
    guidewire should advance easily without
    resistance
    E. With the guidewire in position, remove
    the catheter and use a No. 11 scalpel
    blade to nick the skin. Place the central
    vein catheter over the wire, holding
    the wire secure at all times. Pass the
    catheter into the vein, and suture the
    catheter to the skin with O silk suture.
    Tape the catheter in place, and connect it
    to an IV infusion at a keep open rate
    F. Obtain a chest x-ray to rule out
    pneumothorax and confirm position.
    Subclavian vein cannulation
    The subclavian vein is located in the angle
    formed by the medial 1/3 of clavicle and
    the first rib , At the point of medial 1/3 and
    middle 1/3
    PROCEDURE
    A. Position the patient supine with a rolled
    towel located longitudinally between the
    patient's scapulae,
    and turn the patient’s head towards the
    contralateral
    side. Prepare the area with Betadine
    iodine solution, and, using sterile
    technique, drape the area and infiltrate 1%
    lidocaine into the skin and tissues
    B. Use a 16-gauge needle, with syringe
    attached, to puncture the mid-point of the
    clavicle, advancing until the clavicle bone
    and needle come in contact
    C. Then slowly probe down until the
    needle slips under the clavicle. Advance
    the needle slowly towards the vein until
    the needle enters the vein, and a back
    flow of venous blood enters the syringe.
    Remove the syringe, and cover the
    catheter hub with a finger to prevent air
    embolization
    D. With the 16-gauge catheter in position,
    advance a 0.89 mm x 45 cm guidewire
    through the catheter. The guidewire
    should advance easily without resistance.
    With the guidewire in position, remove the
    catheter, and use a No. 11 scalpel blade
    to nick the skin. Pass the dilator over the
    wire.
    E. Place the central line catheter over the
    wire, holding
    the wire secure at all times. Pass the
    catheter into the vein, and suture the
    catheter to the skin with 2-0 silk suture,
    tape the catheter in place and connect to
    IV infusion. Obtain a chest x-ray to confirm
    the position of the catheter tip and rule out
    pneumothorax

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