This document provides an overview of central venous catheterization. It discusses the types of central venous catheters including non-tunneled, tunneled, peripherally inserted central catheters, and implantable ports. It also covers indications, contraindications, techniques, complications, and tips for placement of central lines in the internal jugular, subclavian, and femoral veins. Ultrasound-guided central venous access is also discussed as the standard of care.
Central Venous Access and Catheters. Their indications and contraindications, Different types of central catheters and their advantages and disadvantages, Technique of insertion, and Complications related to central venous lines.
Central Venous Catheterization without Ultrasound guidanceRunal Shah
In this modern era of USG, you will hardly attempt Central lines blindly. So when your USG machine breaks down, how will you resuscitate the patient? Know your basics about Central venous catheterization.
Central Venous Catheter Care- A Nursing skill Tse Sona
- Shared on the request of al the delegates who attended and those who couldn't attend the webinar on "CVC care- A Nursing Skill'' due to limited seats. I hope it will be helpful to all
Central Venous Access and Catheters. Their indications and contraindications, Different types of central catheters and their advantages and disadvantages, Technique of insertion, and Complications related to central venous lines.
Central Venous Catheterization without Ultrasound guidanceRunal Shah
In this modern era of USG, you will hardly attempt Central lines blindly. So when your USG machine breaks down, how will you resuscitate the patient? Know your basics about Central venous catheterization.
Central Venous Catheter Care- A Nursing skill Tse Sona
- Shared on the request of al the delegates who attended and those who couldn't attend the webinar on "CVC care- A Nursing Skill'' due to limited seats. I hope it will be helpful to all
Angioplasty uses imaging guidance to insert a balloon-tipped catheter into a narrow or blocked blood vessel where the balloon is inflated to open the vessel and improve blood flow. It may be done with vascular stenting – the placement of a small wire mesh tube within the blood vessel to help keep it open. The procedure is much less invasive than other surgical interventions and usually does not require general anesthesia.
In medicine, a central venous catheter ("central line", "CVC", "central venous line" or "central venous access catheter") is a catheter placed into a large vein in the neck (internal jugular vein), chest (subclavian vein or axillary vein) or groin (femoral vein)
This slide will provide illustrative information regarding coronary angioplasty . It also focus on practical area knowledge of cardiac catheterization which one should focus while caring patient with coronary angioplasty.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
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Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
8. Dislodged more easily
Has the highest infection rate
Dressing changes required using aseptic
technique
Unused ports must be routinely flushed
with heparin solution and clamped
NNOOTT FFLLEEXXIIBBLLEE AANNDD MMAAYY BBRREEAAKK
11. Single or multiple lumens
Flow variable
Log term
Inserted surgically
Cuff –dacron, vita
No dressing is required after cuff heals
unless the patient isimmunocompromised
15. Peripherally IInnsseerrtteedd CCeennttrraall
CCaatthheetteerrss ((PPIICCCC))
Used for intermediate to long term
therapy
May be single or double lumen
Inserted percutaneously
◦ Basalic vein
◦ Cephalic vein
Threaded into the superior vena cava
16. PPIICCCC
SILASTIC OR POLYURETHANE
SINGLE OR DOUBLE LUMEN
LOW FLOW
SHORT-LONGTERM
EASY ACCESS
19. LESS MAINTENANCE
ACTIVITY IS UNLIMETED AFTER SITE HEALS
COSMETICALLY MORE APPEALING
CONCEALED PACKET RETARDS
INFECTION
20. Minimizes infection
Huber needle must be used to access port
Must always confirm needle placement before
med administration
Unused port is flushed every 28 days with
Heparin solution
21.
22. IInnddiiccaattiioonnss
Central venous pressure monitoring
Volume resuscitation
Infusion of hyperalimentation
Infusion of concentrated solutions
Placement of transvenous pacemaker
Cardiac catheterization & pulmonary angiography
Temporary Hemodialysis
Lack of peripheral access
24. TTeecchhnniiqquuee
Seldinger technique
◦ Use introducing needle to locate vein
◦ Wire is threaded through the needle
◦ Needle is removed
◦ Skin and vessel are dilated
◦ Catheter is placed over the wire
◦ Wire is removed
◦ Catheter is secured in place
25.
26. BBaassiicc PPrriinncciipplleess
Decide if the line is really necessary
Know your anatomy
Be familiar with your equipment
Obtain optimal patient positioning and cooperation
Take your time
Use sterile technique
Always have a hand on your wire
Ask for help
Always aspirate as you advance as you withdraw the needle
slowly
Always withdraw the needle to the level of the skin before
redirecting the angle
Obtain chest x-ray post line placement and review it
27. Location Advantage Disadvantage
Internal
Jugular
• Bleeding can be recognized
and controlled
• Malposition is rare
• Less risk of pneumothorax
• Risk of carotid artery puncture
• PTX possible
Femoral • Easy to find vein
• No risk of pneumothorax
• Preferred site for
emergencies and CPR
• Fewer bad complications
• Highest risk of infection
• Risk of DVT
• Not good for ambulatory
patients
Subclavian • Most comfortable for
conscious patients
• Highest risk of PTX, should
not do on intubated pts
• Should not be done if < 2 years
• Vein is non-compressible
28. SSuubbccllaavviiaann AApppprrooaacchh
Positioning
◦ Right side preferred
◦ Supine position, head neutral, arm abducted
◦ Trendelenburg (10-15 degrees)
◦ Shoulders neutral with mild retraction
Needle placement
◦ Junction of middle and medial thirds of clavicle
◦ At the small tubercle in the medial deltopectoral groove
◦ Needle should be parallel to skin
◦ Aim towards the suprasternal notch and just under the clavicle
29.
30. IInntteerrnnaall JJuugguullaarr AApppprrooaacchh
Positioning
◦ Right side preferred
◦ Trendelenburg position
◦ Head turned slightly away from side of venipuncture
Needle placement: Central approach
◦ Locate the triangle formed by the clavicle and the sternal and
clavicular heads of the SCM muscle
◦ Gently place three fingers of left hand on carotid artery
◦ Place needle at 30 to 40 degrees to the skin, lateral to the carotid
artery
◦ Aim toward the ipsilateral nipple under the medial border of the
lateral head of the SCM muscle
◦ Vein should be 1-1.5 cm deep, avoid deep probing in the neck
35. PPoosstt--CCaatthheetteerr PPllaacceemmeenntt
Aspirate blood from each port
Flush with saline or sterile water
(heparinised)
Secure catheter with sutures
Cover with sterile dressing (tega-derm)
Obtain chest x-ray for IJ and SC lines
Write a procedure note
37. TTiippss
After 3-4 tries, let someone else try
Get cheast x-ray after unsuccessful attempt
If attempt at one site fails, try new site on same side to
avoid bilateral complications
Halt positive pressure ventilation as the needle penetrates
the chest wall in subclavian approach
If you meet resistance while inserting the guide wire,
withdraw slightly and rotate the wire and re-advance
Align the bevel with the syringe markings
Withdraw slowly, you will often hit the vein on the way out
38. Ultrasound-GGuuiiddeedd CCeennttrraall VVeennoouuss
AAcccceessss
Becoming standard of care
Vein is compressible
Vein is not always larger
Vein is accessed under direct
visualization
Helpful in patients with difficult
anatomy
Basic materials section involves going through an actual catheter kit with them and demonstrating technique
Central venous pressure monitoring – for those whose volume status needs to be managed closely
Volume loading – flow rate through a 14 gauge peripheral line is twice that of a 20cm 16 gauge central venous catheter
Concentrated solutions – potassium chloride, hyperosmolar saline, chemo agents. Or vasoactive substances like epi, dopamine. All can cause tissue irritation or necrosis if extravasated in peripheral line
Bleeding disorders – even with platelet counts &lt;50,000, bleeding is uncommon and easily managed, in the absence of arterial puncture
Distorted local anatomy – ultrasound may help
Seldinger originally described this technique in 1953 for percutaneous arteriography.
UNC preferred site – in the hospital manual
Arm abduction flattens the deltoid bulge
Trendelenburg reduces incidence of air embolism
Shoulders – as the shoulder falls backward, the space between the clavicle and first rib narrows, making the subclavian vein less accessible
Right side preferred – lower pleural dome and thoracic duct on left
Junction of the middle and medial thirds of the clavicle – here the vein in just posterior to the clavicle and just above the first rib which acts as a barrier to the pleura.
Right side preferred – left IJ is more circuitous, thoracic duct on left
Trendelenburg – IJ is distensible
Central approach is most common
Anterior approach has highest risk of puncturing carotid artery
The more distal you are from the inguinal ligament, the closer the vein is to the artery as the femoral vein begins to dive behind the artery and the saphenous vein comes off the femoral vein.
NAVEL – N = nerve, A = artery, V = vein, E = empty space, L = lymphatics
(must be read from right side of body, L is always medial. So it is spelled backwards from the left side approach
Resistance during wire advancement comes from incorrect placement or from valves and tortuous vessels which can be overcome with GENTLE manipulation of the guide wire
Go over kits and demonstrate procedure with students
