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Download Central Venous Access - Sunderland ICCU Medical Education
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Central Venous Access Indications • Peripheral access impossible. • Administration of irritant medications inc. TPN. • Measurement of mixed venous oxygen saturations. • Right heart catheterisation. • RRT / ECMO etc. • NB - NOT fluid status Assessment What aspects of the patient examination and investigations need to be taken into account before inserting a central line? Monitoring and Environment Where should a central line be inserted? What monitoring is required? Infection Control Site What sites are available for central access? What are the advantages / disadvantages of each? Internal Jugular External Jugular Subclavian Femoral PICC Ultrasound • Position the ultrasound screen on the other side of the patient to allow easy viewing • Touch the side of the probe while observing the image to orientate the probe. (Some probes have a mark that corresponds to one side of the screen for this purpose) • Alter the gain to produce a relatively dark image that will help discriminate the white of the needle tip • Use sterile gel inside the probe sheath (and between the sheath and the patient’s skin) to provide acoustic coupling • Throughout the procedure, maintain a sterile environment. (The operator should be wearing a sterile gown, mask, hat and the area should be cleaned before drapes are applied) Short vs Long Axis View How can you differentiate between vein and artery? Veins are (usually)…. • • • • Where you expect then to be Compressible Non-pulsatile Varying in size with respiration, valsalva, fluid loading Seldinger Technique Complications What complications are related to insertion of the line (immediate complications)? • Arrhythmias • Venous bleeding • Arterial bleeding • Pneumothorax • Cardiac perforation • Embolisation (air or thrombus) • Retained wire What adjacent structures can be damaged when attempting IJV cannulation? • Thoracic duct • Vagus nerve • Brachial plexus • Phrenic nerve • Stellate Ganglion • Glossopharyngeal nerve What are the potential delayed complications? • Sepsis • Extravasation (dislodgement) • Thrombosis CXR Position Good Position Abutting SVC
