تتحدث الوثيقة عن إدخال القسطرة الوريدية المركزية (CVC) واستخداماتها في العلاج، حيث تُحدد الموقع المفضل للإدخال والاحتياطات خلال العملية. تعرض الوثيقة أيضًا مؤشرات وموانع استخدام القسطرة، بالإضافة إلى الإجراءات اللازمة لرصد ضغط الوريد المركزي (CVP) ومعدات الاستخدام. تتناول الوثيقة أيضًا العوامل التي تؤثر على قراءة ضغط الوريد المركزي وإجراءات للتوثيق.

1. ‫صنعاء‬ ‫جامعة‬
‫الصحية‬ ‫والعلوم‬ ‫الطب‬ ‫كلية‬
‫عالي‬ ‫تمريض‬
‫إشراف‬ ‫حتت‬
:
‫د‬
/
‫موسى‬
‫الفقية‬
‫د‬
/
‫حفيظ‬ ‫بسام‬
‫د‬
/
‫غمدان‬
‫جباش‬
‫الطالب‬ ‫إعداد‬
:
‫حزام‬ ‫علي‬ ‫امحد‬ ‫طه‬
‫املهظاني‬

2. Definition Of CVC:
Is indwelling intravenous device that
inserted into a vein of the central
vasculature

3. Indications of CVC:
1. Volume resuscitation
2. Emergent venous access
3. Nutritional support
4. Inotropes
5. Hemodialysis
6. For long term administration of drugs
7. Central venous pressure(CVP) Monitoring

4. Regular site:
Catheters can be placed in veins
1. Neck (internal jugular vein)
2. Chest (subcalvin vein or axillary vein)
3. Groin (femoral vein)
4. Peripherally inserted central catheters (PICC)

6. Tunneled-catheters
❑ Preferable sites:
• Neck (internal jugular)
• Groin (femoral)
• Liver (transhepatic).the
catheter is tunneled under
the skin.
❑ Indications:
• Chemotherapy
• nutritional
• Fluids
• Blood samples
Non tunneled-catheters
❑ Preferable sites:
• First choice: right internal jugular vein
• Second choice: femoral vein
• Third choice: left internal jugular vein
• Last choice: subclavian vein with
preference for the dominant side
❑ Indications:
• Increasing age of patients initiating
hemodialysis
• Increasing number of comorbid
conditions including significant
vascular disease
• Urgent renal replacement therapy
(RRT)

7. Contraindications:
1. Patients undergoing thrombolytic or
anticoagulation therapy
2. Bleeding disorders or coagulopathies
like(hemophilia ,DIC ,…..)
3. Vasculitis
4. Distorted local anatomy
5. Overlying skin infections(dermatitis),burns ,
cellulitis
6. Uncooperative patient

8. Complications:
1. Infectious: sepsis (also septic arthritis,
osteomyelitis)
2. Vascular: air embolism, blood clot, hematoma,
arterial puncture, thrombophlebitis.
3. Others: pneumothorax, hemothorax, arrhythmias,
nerve injury, bladder perforation

9. Equipment:
1. Septic solution
2. Local anesthetic (lidocaine)
3. Sterile gauze, gloves, gown, syringe,
catheter
4. Disinfectant (povidone-iodine solution
,chlorhexidine)
5. Dilator, drapes and guide wire
6. Suturing and several needle

10. Procedure:
✓ Obtain informed consent
✓ Examine the patient to be sure that there are no
contraindications
✓ Place the patient in Trendelenburg position
✓ Set up the equipment and sterile preparations
✓ Sterile the area of the insertion
✓ Local anesthesia should be used
✓ Location of the vine
✓ Insertion of the introducer needle into the
vein
✓ Assessment of venues or arterial placement

11. Procedure:
✓ Insertion of guide wire
✓ Removal of the introducer needle
✓ Skin incision at the site of insertion of guide
wire
✓ Insertion of the dilator
✓ Removal of the dilator and insertion of the
catheter over the guide wire
✓ Removal of guide wire
✓ Flushing and capping of the lumens
✓ Securing the catheters with sutures

12. N/C:
1. Keep patient in comfortable position (supine
position)
2. Frequently dressing of site of CVC insertion
3. Should be cover
4. Flushing after and between uses
5. Frequency of flushing and flushing solutions
6. Care of the exit site
7. Dressings immediately post insertion
8. Give antibiotic or ointment around CVC insertion
to prevent infection
9. Check vital sings

13. Documentation:
1. Patient is educated about the need
2. Patient is educated about the need
3. All lumens clamped
4. Inserted by Physician
5. Tip position confirmation via fluoroscopy OR chest
X-ray
6. Date and time of insertion , assess the site for
extra bleeding
7. Anatomical location
8. Catheter depth according to catheter reference

14. Central Venous Pressure

15. Definition of CVP:
Central Venous Pressure (CVP) is the pressure of blood
in the thoracic vena cava at the point where the
superior vena cava meets the inferior vena cava prior
to entry into the right atrium (RA) of the heart
The normal range of CVP is:
5-10 cm H2O /1-7 mmHg

16. Purposes for CVP monitoring:
1. To serve as a guide for fluid replacement
2. To monitor pressures in RA & central vein
3. To administer blood products, TPN & drug
therapy contraindicated for peripheral
infusion
4. To obtain venous access when peripheral
venous sites are inadequate
5. To insert a temporary pacemaker
6. To obtain Central venous blood samples

17. Factors that increase CVP include:
1. Cardiac tamponade
2. Decreased cardiac output
3. Forced exhalation
4. Heart failure
5. Hypervolemia
6. Mechanical ventilation and the application of
positive end-expiralory pressure (PEEP)
7. Pleural effusion
8. Pulmonary embolis
9. Pulmonary hypertension
10.Tension pneumothorax

18. Factors that decrease CVP include:
1. Deep inhalation
2. Distributive shock
3. Hypovolemia
4. Jugular venous pressure
5. pulmonary capillary wedge pressure
6. sever diarrhea
7. bleeding
8. dehydration
9. Vomiting

19. Equipment:
1. Venous pressure tray
2. Cut down tray
3. Disposable CVP manometer set
4. Leveling device (such as rod from reusable CVP pole
holder or carpenter's level or rule)
5. 3 way or 4 way stopcock (a pressure transducer may also
be used)
6. Antiseptic pad
7. Extension tubing. If needed
8. IV pole
9. IV solution (usually normal saline)
10. IV drip chamber and tubin
11. Adhesive lape
12. ECG monitor

21. Procedure:
1. Assess the patient's respiratory and cardiac
2. Wash hands and wear gloves.
3. Select the appropriate CVC lumen
4. Assess the patient's respiratory and cardiac
5. Wash hands and wear gloves.
6. Select the appropriate CVC lumen
7. Begin the IV solution such as normal saline
8. Close the stopcock in the direction of the patient.
9. Allow the solution to pass via the manometer line.
10.Check the patency of the catheter and lumen
through flush back or using a syringe.
11.Positioning the patient in an appropriate position

23. Procedure:
12. IfFlat: Put the manometer at the mid axillary's line of the
patient (fifth intercostal space).
Folwers or Semi Folwers: Put the manometer at the mid
axillary's line of the Patient (second intercostal space).
12. Close the stopcock in the direction of the solution.
13. Take the CVP reading when fluid stop fluctuate.
(normal 5-15 cmHg).
14. Begin an I.V solution such as normal saline to flush the
catheter or hep saline better If not contraindicated.
15. Put the patient in comfort position.
16. Remove gloves and wash hands.
17. Documentation (Date, Time, CVP reading and catheter
insertion site).