Intraindication: Electrocardiography And Pulse AXIS
To give medications to the patient e.g. vasopressors, chemotherapy, antibiotics1
Parentral nutrition (PEN)
Hemodynamic monitoring – e.g. central venous pressure (CVP)
In case of difficult or poor peripheral venous access
CONTRAINDICATION: some of the relative contraindications are
Anatomic distortion at insertion site
Already existing intravascular devices
Internal juglar vein (IJV)
Suvclavian vein ( SCV)
MONITORING: – Essential monitoring required – electrocardiography (ECG) and Pulse Oximeter (SpO2).
Aim of positioning during the procedure should be to maximize the diameter of vein and obtain maximum comfort.
Most adequate position is Supine. …show more content…
Non pulsatile Pulsatile
Distend with Not distend oValsalva oValsalva oTrendelenburg position oTrendelenburg position
Doppler Doppler oSteadier “hum” oSharp “whoose”
Spectral Spectral oUndulating waveform oSharp upstroke
SHORT AXIS VS LONG AXIS
SHORT AXIS / OUT OF PLANE LONGITUDINAL AXIS / IN PLANE
Transverse visualization of vein Longitudinal visualisation of vein5
Vein - a dark circle Vessel – dark, thick line
Needle - bright dot Entire length of the needle can be seen screen
Place probe 90º to vein, vein appears as cross section 1st identify vein in transverse axis and then rotate the probe 90º
Needle tip /entire length difficult to visualise Needle tip /entire length & J tip guidewire can be visualised
Easier because oSimultaneously can see both vein & artery oCan differentiate between vein and artery by compression Little cumbersome oSimultaneously cannot see both vein & artery oTechnically difficult to maintain centre of vein
Apply gel to probe footprint
Place probe into a sterile covering /sleeve
There should be no air between footprint and covering
Secure sterile cover with rubber band
INTERNAL JUGLAR VEIN …show more content…
Indications for left IJV : oRight sided prior cannulation oRight sided scarring on cannulation site oRight sided thrombosis / Devices
APPROACHES: There are three approaches for IJV cannulation central, anterior and posterior. Central approach - Commonly used
Position: supine or slight trendeleberg.
Puncture site is at apex of triangle
Approximately 5 cm above the clavicle
Needle should be directed towards ipsilateral nipple, angle of insertion should be about 30-45º SUBCLAVIAN VEIN
Site of needle insertion is 1 cm inferior to the junction of the middle and medial third of the clavicle at the deltopectoral groove.
Supraclavicular - is not preferred because of high incidence of pneumothorax
Infraclavicular - is the most common approach.
Supine with slight retraction of shoulder
Trendelenberg reduces the chance of occurrence of VAE