Clinical use : 3 puncture sites
We can identify 3 puncture sites on the human body for the central venous catheter.
Clinical use - Comparison
| Femoral | Jugular | Subclavian | |
|---|---|---|---|
|
Operation |
Easiest |
High tech |
Easy |
|
Complication |
Raw and slight |
Possible and fatal |
Low possibility |
|
Remaining time |
1 week, additional care needed after one week |
3-4 weeks |
3-4 weeks |
|
Body position |
supine position (except heart failure and difficul breathing) |
Head down position |
Head down position |
|
Activities |
Inconvenient |
Inconvenient |
Head moving is limited |
|
Blood flow |
Good blood flow rate, depend on the position of insertion |
Good blood flow rate |
Good blood flow rate |
|
Blood flow and difficulty |
Lack of long term observation, used for short term. Embolism's possibility is low. |
Embolism's possibility is high. Operation is uneasy. |
Embolism's possibility is low. Operation is easy. |
Placement procedure
1) Place the patient in a trendelenberg position (15 to 30 degrees head down) to reduce the chance of an air embolism, turn the patient’s head to the side contralateral to choose the site.
2) mark puncture site
3) Anesthetize the spot by using needle, the angle between needle and skin shall be 30 to 45 degrees
4) when a flush of blood returns by advancing the needle, insert venous needle.
Remarks: pay attention to the direction of needle and color of blood returns during advancing seeker needle, meanwhile, pay attention to the direction of needle and depth of puncturing needle, the bevel of needle shall be faceup.
5) one hand hold the needle, another hand hold the syringe, keep the pressure negative during the slow insertion. When you feel the needle placed into the vein, the blood will return smoothly.
6) Guidewire will be inserted through Y shaped syringe or hollow syringe.
Remarks: during the insertion of guidewire，please judge the resistance , don’t withdraw the guidewire by force, withdraw the guidewire together with syringe if necessary.
7) withdraw syringe, and insert dilator by 1-2 cm under the skin for enlarge the track.
Remarks: During insertion of dilator, attention shall be paid to the direction and the force of dilator, especially the force transferring between dilator and guidewire, the driving force shall be increased gradually
8）Withdraw the dilator, implant the catheter from the end of guidewire, and saline shall be injected into to the catheter immediately.
9）Ensure the whole catheter implanted completely and then fixed the catheter at the final position.
10）Connect with other tubes and devices
Remarks: The force for inserting the catheter is related to enlarging of the track, if the resistance is big, the length of each insertion shall be shorter, and attention shall be paid to avoid kink of guidewire.
Nursing care after placement of the catheter
Factors which can cause blockage of catheter:
- Mechanical factors
- Non-embolism factors
- Continuous infusion: the change of body position cause return of blood
- Infusion of blodd porducts in case of part of catheter bloced, accumulated fibrin makes lumens smaller, even complete blockage
- Patient’s factor: blood viscosity increase, blood stasis in vein, return of blood, overtime of measurement of CVP, increase of intracranial pressure, frequent vomit, cough and hiccup.
- Catheter’s factors
- The choice of puncturing site
- Embolism factors
- Leakage of introducer syringe
- Leakage of catheter
- Insufficient flow rate
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