Podcast
Questions and Answers
What is the primary purpose of applying a tourniquet during venous cannulation?
What is the primary purpose of applying a tourniquet during venous cannulation?
- To reduce blood flow
- To engorge distal veins (correct)
- To constrict the artery
- To clean the skin
What is a relative contraindication for venous cannulation?
What is a relative contraindication for venous cannulation?
- Local infections
- Arteriovenous fistula formation
- Deep vein thrombosis
- All of the above (correct)
Which of the following is a consideration for choosing the non-dominant upper extremity for venous cannulation?
Which of the following is a consideration for choosing the non-dominant upper extremity for venous cannulation?
- Less risk of extravasation (correct)
- Less risk of infection
- Patient comfort
- Easier access to the vein
What is the recommended technique for cleaning the skin before venous cannulation?
What is the recommended technique for cleaning the skin before venous cannulation?
What is the purpose of rubbing or warming the skin around the target vein?
What is the purpose of rubbing or warming the skin around the target vein?
What is the recommended approach for locating a suitable vein for cannulation?
What is the recommended approach for locating a suitable vein for cannulation?
How should the cannula be held during venous cannulation?
How should the cannula be held during venous cannulation?
What is the purpose of stabilizing the vein during venous cannulation?
What is the purpose of stabilizing the vein during venous cannulation?
What is the benefit of instructing the patient to repeatedly open and close their hand during venous cannulation?
What is the benefit of instructing the patient to repeatedly open and close their hand during venous cannulation?
What is the recommended site for venous cannulation in terms of convenience and risk?
What is the recommended site for venous cannulation in terms of convenience and risk?
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Study Notes
Central Line Placement
- Strict aseptic technique is essential, including handwashing, gowning, draping, and sterile preparation of the access site.
Insertion Technique
- Infiltrate the skin with 1% Lidocaine around the insertion site.
- Insert an 18-gauge introducer needle at a 45-degree angle at the apex formed by the two heads of the SCM.
- Advance the needle lateral to the carotid pulsation, directed towards the ipsilateral nipple, while aspirating.
- Once venous blood is aspirated, remove the syringe and thread the guidewire through the introducer into the vessel up to the superior portion of the IVC (~15-16cm for Right IJV).
ECG Tracing
- P-wave: Atrial depolarization
- PR interval: Conduction from atria to ventricles
- PR segment: Reference isoelectric line
- QRS complex: Ventricular depolarization
- QT interval: Duration of ventricular depolarization to repolarization
- ST segment: Plateau phase of the cardiac cell potential
- T-wave: Ventricular repolarization
ECG Placement
- Limb leads: Standard (I, II, III) and augmented (aVR, aVL, aVF)
- Chest leads: V1-V6, with specific placement locations
Contraindications
- No absolute contraindications
- Relative contraindications: Local infections and burns on the intended site of insertion, and arteriovenous fistula formation or deep vein thrombosis on the affected limb
Site Selection
- Internal jugular vein: Right IJV is often preferred due to its direct route to the right atrium
- Subclavian Vein: Provides a direct route to the right atrium but has higher risk for pneumothorax and bleeding
- Femoral vein: Used for patients with high risk of bleeding, but generally avoided due to increased risk of catheter-related deep vein thrombosis
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