Central Venous Catheterization Lecture Notes PDF

CENTRAL VENOUS CATHETERIZATION Carnation P. Uyag, RN  INTRODUCTION Central venous access refers to lines placed into the large veins of the neck, chest or groin and is frequently performed invasive procedure which carries a significant risk of morbidity and even mortality. This pro...

CENTRAL VENOUS CATHETERIZATION Carnation P. Uyag, RN  INTRODUCTION Central venous access refers to lines placed into the large veins of the neck, chest or groin and is frequently performed invasive procedure which carries a significant risk of morbidity and even mortality. This procedure should be carried out in operating theater or high-dependency care areas, always using a fully aseptic technique  INDICATIONS Monitoring of central venous pressure in critically ill patient and after major surgery Infusion of irritant drugs that may damage smaller veins Insertion of pacing wires Renal placement therapy Emergency venous access Parenteral feeding Resuscitation of patient’s who are intravascularly depleted  RELATIVE CONTRAINDICATIONS Uncorrected coagulopathy Thrombocytopenia Skin infection over the site of access Obscure anatomical landmarks Hemo or pneumothorax on the contralateral side Recent surgery to other structures nearby such as carotidendartectomy  SITES Right Subclavian Vein Internal Jugular Vein Femoral Vein  SITE ADVANTAGE DISADVANT AGE Low risk of Highest chance Subclavia infection of n Does not require pneumothorax Puncture of movement of patient’s head tracheostomy or and can be ET tube cuff accessed during Cannot apply c-spine pressure to stop immobilization bleeding Useful in Can be painful emergencies even with good Vein does not skin anesthesia collapse fully in Less easy to  SITE ADVANTAGE DISADVANT AGE Anatomy readily Puncture of Internal visible with internal carotid Jugular ultrasound Can be adapted or misplaced line in the internal (IJ) to accommodate carotid patient size and Pneumothorax is position recognized Easily accessed complication surface of the Difficult to nurse patient long term  SITE ADVANTAGE DISADVANT AGE Safest vein to Femoral artery FEMORAL place large lines, bleeding leading for example to veno retroperitoneal hemofiltration bleed because there Femoral nerve are fewer damage important Difficult to nurse structures and keep clean nearby Highest Puncture of likelihood of femoral artery infection can usually Central line kit Additional Items: containing: Needle or a cannula over Suture needle Scalpel Central venous catheter Appropriate dressing Guidewire Syringer Dilator Blue and green needles Anchoring clips Three-way taps, one for each lumen Drape Cleaning fluid ( 2% chlorhexidine gluconate in 70% isopropyl alcohol is recommended) Swabs Gallipot or similar Sterile ultrasound probe sheet  BASIC PRINCIPLES Must decide if the line is really necessary Should know the anatomy Should be familiar with the equipment Must obtain optimal patient positioning and cooperation Should not rty to do it fast Must use sterile technique Always have a hand on the guide wire Should ask for help if necessary Always withdraw the ne nedle to the level of the skin before redirecting the angle Obtain chest x-ray post line placement and review it SUBCLAVIAN APPROACH INTERNAL JUGULAR CENTRAL APPROACH THANK YOU