Download Central Venous Catheters

Central Venous Catheters
25/11/10
PY Mindmaps
USES/INDICATIONS
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(2)
(3)
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IV access
CVP monitoring
ScvO2 monitoring/sampling
Vasoactive or TPN administration
Renal replacement therapy
Transvenous pacing
CONTRAINDICATIONS
- coagulopathy
- respiratory failure
- raised ICP
-> can use femoral approach in all these situations
DESCRIPTION
- multi-lumen catheter
METHOD OF INSERTION AND/OR USE
- aseptic technique
- U/S guided (if possible)
- head down (IJ, SC)
Jeremy Fernando (2011)
- head up (femoral)
Internal Jugular
- anatomy:
-> course: from jugular foramen -> joins subclavian vein behind sternal extremity of clavicle
-> medial: internal and common carotid, 9th to 12th cranial nerves above common carotid +
vagus
-> anterolateral: skin, superficial fascia, platysma, cervical fascia, sternomastoid, sternohyoid,
omohyoid
-> posterior: transverse process of the cervical vertebrae, levator scapulae, scalenus medius
and anterior, cervical plexus, phrenic nerve, thyrocervical trunk, vertebral vein, 1 st part of
subclavian artery
-> tributaries: inferior petrosal sinus, facial, pharyngeal, lingual, superior thyroid, middle
thyroid, occipital veins
- central approach: find 1cm above the apex of head of SCM and clavicle -> 60 degrees to
skin aiming towards ipsilateral nipple (blood should be obtained within 3cm)
- lateral/posterior approach: find 2-3 finger breaths above clavicle along posterior border of
SCM, direct needle towards jugular notch (blood should be aspirated within 5cm)
- anterior approach: identify the carotid and mid point of medial SCM border, aim toward
ipsilateral nipple
Subclavian
- anatomy:
-> superior: midpoint of clavicle
-> anterior: skin, external jugular vein, clavicle
-> medial: fascia, trachea
-> posterior: subclavian artery, first rib, scalenus anterior, phrenic nerve and fascia over
pleura
- approaches: supraclaviclar, infraclavicular and lateral
Femoral
- anatomy:
-> VAN
-> boundaries of the femoral triangle are adductor longus and sartorius
- approach: slight external rotation of hip, palpate pulse, medial to arterial pulsation
OTHER INFORMATION
COMPLICATIONS
Jeremy Fernando (2011)
Immediate
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pneumothorax
failure to locate vein
accidental arterial puncture
haemothorax
haematoma
arrhythmia
thoracic duct injury
Early
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haemopericardium and tamponade
pneumothorax
catheter blockage
chylothorax
catheter knots
Late
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infection
catheter fracture
vascular erosion
thrombosis
osteomyelitis of clavicle
Jeremy Fernando (2011)