This document outlines the indications and techniques for central venous catheterization, emphasizing the choice of the internal jugular vein for cardiac anesthesia due to its anatomical advantages. It details the types of catheters, methods of insertion, and post-insertion protocols, while also addressing potential complications. The document highlights the use of ultrasound guidance and the need for specific equipment to enhance the safety and effectiveness of the procedure.

1. CENTRAL VENOUS
CATHETERIZATION
DR. MD. SHARIF HASAN
MBBS, DA
Specialist, Cardiac Anaesthesia
SQUARE HOSPITALS LTD.

2. INDICATIONS
 Central Venous Pressure Monitoring
 Hemodynamic Monitoring
 Volume Resuscitation

3. INDICATIONS
 Administration of
Drugs likely to
induce Phlebitis (eg-
Potassium,
Amiodarone, 3%
NaCl)
 Administration of
Multiple Ionotrops

4. INDICATIONS
 Lack of Peripheral Access
 Repeated Blood Sampling
 Parenteral Feeding

5. CHOISE OF VEINS
 Internal Jugular Vein
 Subclavian Vein
 External Jugular Vein
 Chephalic Vein
 Femoral Vein
Subclavian

6. IN CARDIAC ANESTHESIA
Our Choice is Internal Jugular
Vein (IJV)
WHY?
Because-
 Free of Surgical Site
 Actual CVP can be Measured
 Anatomically closure to RA
 It has no valves

7. D.H. LAWRENCE QUOTE:
“THE EYES DON'T SEE WHAT THE
MIND DOESN'T KNOW.”

8. SURFACE MARKING OF IJV

9. SURFACE MARKING OF IJV
Sternocleidomastoid-Clavicle
Triangle

10. SURFACE MARKING OF IJV

11. INSTRUMENTS FOR
CATHETERIZATION

12. INSTRUMENTS FOR
CATHETERIZATION

13. INSTRUMENTS FOR
CATHETERIZATION

14. TYPES OF CATHETER
 According to Duration
 Non-Tunneled (Short duration)
 Tunneled
 Peripherally inserted
 Implantable ports
 According to Lumen
 Single Lumen
 Multiple Lumen (Double, Three
lumen, Four Lumen)

15. TYPES OF CATHETER
 According to Valve
 Open Ended (no valve)
 Closed Ended (presence of valve)

16. TECHNIQUE OF INSERTION
Blind Technique USG Guided
Technique

17. BLIND TECHNIQUE
 Right side preferred – lower
pleural dome and thoracic duct
on left
 Trendelenburg position – 10-15
degrees
 Head rotated approximately 15
degree to left
 At cricoid level while palpating
the carotid pulse, introducer
needle into the apex of the
sternocleidomastoid-clavicular
triangle at a 30-40 degree angle
to the skin. Aim the needle
caudally towards the patient’s
ipsilateral nipple.

18. SELDINGER
TECHNIQUE
 Wire is threaded
through the needle
 Needle is removed
 Skin and vessel are
dilated with the
Dilator
 Catheter is placed
over the wire
 Wire is removed
 Catheter is secured
in place

19. POST-CATHETER
PLACEMENT
 Aspirate blood from
each port
 Flush with Heparin
saline
 Secure catheter with
sutures
 Cover with sterile
dressings
 Obtain chest X-ray and
or USG

20. USG GUIDED TECHNIQUE

21. DISADVANTAGES OF IJV
CATHERIZATION
 Risk of Carotid Artery puncture and Large
Hematoma
 Pneumothorax

22. COMPLICATIONS
 Acute:
 Cardiac Dysarrythmia
 Hematoma formation
 Lost Guide-Wire
 Air Embolism
 Mechanical injury to nearby structure

23. COMPLICATIONS
 Chronic
 Infection
 Non-function or Blockage
 Thromboembolism
 Catheter fragmentation

26. WHAT WE NEED ???
USG
Machine