4. • Check length with plain x-ray film.
• Trendelenburg position.
• Sterile gown, mask, cap, gloves.
• Sterilize a sufficient area around the site of insertion.
• Local anesthesia.
• The puncture site >>>>> outer third of the clavicle, the needlepoint should
start from the point of 1–2 finger widths toward the tail from the center of the
clavicle and go toward the suprasternal area.
5. • Reversed blood flow.
• Insert guidewire smoothly.
• Follow up the ECG, if abnormal heartbeats or irregularities, pull the
wire little outside.
• Insert dilator.
• Lastly insert the catheter.
• fix the catheter.
• Follow up plain x – ray chest.
9. • Internal jugular vein.
• Femoral vein.
• Turn the head of the patient to the left.
• Check of the right sternocleidomastoid muscle.
• Sterile gown, mask, cap, gloves.
• Sterilize a sufficient area around the site of insertion.
• Local anesthesia.
10. • Puncture site: the vertex of the triangle formed by the
sternocleidomastoid muscle attachment sits on the clavicle and the
sternal bone, and the clavicle.
• A mosquito pean to dilate the skin and platysma, and the
sternocleidomastoid muscle below them will be exposed.
• Vertically split the sternocleidomastoid muscle and then the internal
jugular vein covered with a sheath becomes directly visible.
11. • Vein exposure and puncture.
• Guidewire.
• Reversed blood flow.
• Insert the catheter to the limit.
• Fix to the skin.
16. • Catheter tube and a reservoir which is embedded under the skin.
• For administration of anticancer drugs and long-term nutrition.
• Basal plane sizes: reservoirs >>> 25–30 mm and the height range is 10–15 mm.
• Typical insertion sites: subclavian and internal jugular veins.
• Two processes: catheter insertion and reservoir placement.
• Fluoroscopy is essential to identify the location of the catheter tip.
17.
18.
19. • After the guide wire insertion, an incision 1 cm on the skin for insertion of the sheath
introducer.
• Insert the sheath introducer into the vein.
• Rotating the sheath introducer equipped with a dilator through the guide wire to dilate the
route.
• Withdraw the dilator and leave the sheath introducer only.
• Close off the sheath introducer outlet using one finger to prevent bleeding and air tapping.
• Insert the catheter through the sheath introducer under the fluoroscopic guidance.
• Peel away and withdraw the sheath introducer.
20.
21. • Reservoir placement process: appropriate position, incision of approximately 2.5 cm
in the skin.
• Create a subcutaneous pocket equivalent to the size of the reservoir.
• A subcutaneous thickness of 5–20 mm on the reservoir.
• The skin incision must not overlap with the placement site of reservoir unit.
• With the tunneller , develop a subcutaneous tunnel between the catheter insertion
site and the skin incision for reservoir placement.
22.
23. • Connect the peripheral side of the catheter with the tunneller, let it
through the subcutaneous tunnel and carefully draw it through to the
subcutaneous pocket for reservoir placement.
• Fix it to the fascia of the pectoral major muscle using two- or three-
point suturing.
• Use the non-corning needle (Huber needle) to puncture the reservoir
to check for any obstruction.
26. • Administration of anticancer drugs and long-term nutrition management.
• Has a Dacron cuff on the catheter tube.
• Minimum diameter: 2.7 Fr for a single lumen and 5 Fr for double lumens.
• Typical insertion sites: subclavian and internal jugular veins.
• Insertion of the catheter / placement of the Dacron cuff.
•
35. 1. Pneumothorax.
2. Hemothorax.
3. Malposition of Catheter Tip.
4. Arterial puncture: subclavian artery.
5. Injury to the thoracic duct: on the left side.
