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9 Cards in this Set
- Front
- Back
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Indications
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Peripheral venous access is required for:
-fluid admin - med admin Central venous access req'd for: -Parenteral nutrition -CVP monitoring -Cardiac pacing -Difficult peripheral access |
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Techniques
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•Aseptic techniques should be used for all cannulations
• Local anaesthetic should be used for central catheters • Techniques of gaining access include: ○ Catheter over needle ○ Catheter through needle ○ Seldinger technique ○ Surgical cutdown |
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Seldinger technique
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•There are four steps to the Seldinger technique
○ Venepuncture is performed with a introducer needle ○ A soft tipped guide wire is passed through the needle and the needle removed ○ A dilator is passed over the guide wire ○ Dilator is removed and catheter is passed over wire and wire is removed • Chest x-ray should be performed to check position of catheter |
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Venous Cutdown
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• Useful for gaining access in shocked hypovolaemic patient
• Commonest sites used are: ○ Long saphenous vein at ankle – 2 cm anterior to medial malleolus ○ Basilic vein at elbow – 2.5 cm lateral to medial epicondyle • At both sites vein is dissected and ligated distally • Small transverse venotomy is made • Cannula is passed through venotomy and secured |
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Anatomy of Venous Access: Internal Jugular Vein
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○ Right sided access preferred
○ Apical pleura does not rise as high on right and avoids thoracic duct ○ Patient positioned head down ○ In the low approach triangle formed by two heads of sternomastoid and clavicle identified ○ Cannula aimed down and lateral towards ipsilateral nipple |
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Anatomy of Venous Access: Subclavian Vein
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○ Usually approached from below clavicle
○ Paitent positioned head down ○ Needle inserted below junction of medial 2/3 and lateral 1/3 of the clavicle ○ Needle aimed towards suprasternal notch ○ Passes immediately behind clavicle ○ Vein encountered after 4-5 cm |
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Early complications
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• Haemorrhage
• Air embolus • Pneumothorax • Cardiac arrhythmias • Pericardial tamponade • Failed cannulation |
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Late complications
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• Venous thrombosis
• Infection |
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Central Line Infection
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• 10% of central lines become colonized with bacteria
• 2% of patients in ITU develop • Usually due to coagulase-negative staphylococcus infection • Occasionally due to Candida and Staph. Aureus • Infection can be prevented by aseptic techniques and adequate care of lines • Closed systems should be used at all times • Dedicated lines should be used for parenteral nutrition • Antimicrobial coating of lines may reduce the risk of infection |
