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Central Venous Catheterization

This document provides guidance on central venous catheterization including indications, contraindications, complications, techniques, and tips. It describes the Seldinger technique for placement and specifics on internal jugular, subclavian, and femoral approaches. Proper patient positioning, sterile technique, and post-procedure care are emphasized to reduce risks of complications like pneumothorax, infection, and thrombosis. Ultrasound guidance is recommended to aid visualization and reduce risks.

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Erwan Ahmad D
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44 views

Central Venous Catheterization

This document provides guidance on central venous catheterization including indications, contraindications, complications, techniques, and tips. It describes the Seldinger technique for placement and specifics on internal jugular, subclavian, and femoral approaches. Proper patient positioning, sterile technique, and post-procedure care are emphasized to reduce risks of complications like pneumothorax, infection, and thrombosis. Ultrasound guidance is recommended to aid visualization and reduce risks.

Uploaded by

Erwan Ahmad D
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Central Venous

Catheterization
Objectives
 Indications and Contraindications
 Complications
 Technique
 Basic principles
 Specifics by Site
 Tips
 Basic materials
Indications
 Central venous pressure monitoring
 Volume resuscitation
 Cardiac arrest
 Lack of peripheral access
 Infusion of hyperalimentation
 Infusion of concentrated solutions
 Placement of transvenous pacemaker
 Cardiac catheterization, pulmonary angiography
 Hemodialysis
Relative Contraindications
 Bleeding disorders
 Anticoagulation or thrombolytic therapy
 Combative patients
 Distorted local anatomy
 Cellulitis, burns, severe dermatitis at site
 Vasculitis
Complications
 Vascular
– Air embolus
– Arterial puncture
– Arteriovenous fistula
– Hematoma
– Blood clot
 Infectious
– Sepsis, cellulitis, osteomyelitis, septic arthritis
 Miscellaneous
– Dysrhythmias
– Catheter knotting or malposition
– Nerve injury
– Pneumothorax, hemothorax, hydrothorax, hemomediastinum
– Bowel or bladder perforation
Technique
 Seldinger technique
– Use introducing needle to locate vein
– Wire is threaded through the needle
– Needle is removed
– Skin and vessel are dilated
– Catheter is placed over the wire
– Wire is removed
– Catheter is secured in place
Basic Principles
 Decide if the line is really necessary
 Know your anatomy
 Be familiar with your equipment
 Obtain optimal patient positioning and cooperation
 Take your time
 Use sterile technique
 Always have a hand on your wire
 Ask for help
 Always aspirate as you advance as you withdraw the
needle slowly
 Always withdraw the needle to the level of the skin before
redirecting the angle
 Obtain chest x-ray post line placement and review it
Location Advantage Disadvantage

Internal • Bleeding can be recognized • Risk of carotid artery puncture


and controlled • PTX possible
Jugular • Malposition is rare
• Less risk of pneumothorax

• Easy to find vein • Highest risk of infection


Femoral
• No risk of pneumothorax • Risk of DVT
• Preferred site for • Not good for ambulatory
emergencies and CPR patients
• Fewer bad complications

• Most comfortable for • Highest risk of PTX, should


Subclavian not do on intubated pts
conscious patients
• Should not be done if < 2 years
• Vein is non-compressible
Subclavian Approach
 Positioning
– Right side preferred
– Supine position, head neutral, arm abducted
– Trendelenburg (10-15 degrees)
– Shoulders neutral with mild retraction
– Right side preferred
 Needle placement
– Junction of middle and medial thirds of clavicle
– At the small tubercle in the medial deltopectoral groove
– Needle should be parallel to skin
– Aim towards the supraclavicular notch and just under the clavicle
Internal Jugular Approach
 Positioning
– Right side preferred
– Trendelenburg position
– Head turned slightly away from side of venipuncture

 Needle placement: Central approach


– Locate the triangle formed by the clavicle and the sternal and
clavicular heads of the SCM muscle
– Gently place three fingers of left hand on carotid artery
– Place needle at 30 to 40 degrees to the skin, lateral to the carotid
artery
– Aim toward the ipsilateral nipple under the medial border of the
lateral head of the SCM muscle
– Vein should be 1-1.5 cm deep, avoid deep probing in the neck
Internal Jugular Central Approach
Femoral Approach
 Positioning
– Supine
 Needle placement
– Medial to femoral artery
– Needle held at 45 degree angle
– Skin insertion 2 cm below inguinal ligament
– Aim toward umbilicus
Femoral nerve

Femoral Vein
Femoral artery

NAVEL
Post-Catheter Placement
 Aspirate blood from each port
 Flush with saline or sterile water
 Secure catheter with sutures
 Cover with sterile dressing (tega-derm)
 Obtain chest x-ray for IJ and SC lines
 Write a procedure note
Procedure Note
 Name of procedure
 Indication for procedure
 Comment on consent, if applicable
 Describe what you did, including prep
 Comment on aspiration/flushing of ports
 How did patient tolerate procedure
 Any complications
Tips
 After 3-4 tries, let someone else try
 Get chest x-ray after unsuccessful attempt
 If attempt at one site fails, try new site on same side to avoid
bilateral complications
 Halt positive pressure ventilation as the needle penetrates the
chest wall in subclavian approach
 If you meet resistance while inserting the guide wire,
withdraw slightly and rotate the wire and re-advance
 Align the bevel with the syringe markings
 Use the vein on the same side as the pneumothorax
 Withdraw slowly, you will often hit the vein on the way out
Ultrasound-Guided Central
Venous Access
 Becoming standard of care
 Vein is compressible
 Vein is not always larger
 Vein is accessed under direct
visualization
 Helpful in patients with
difficult anatomy
Needle entering IJ
Femoral Compression of vein
Artery with US probe

Femoral
Vein
Catheterization Kits
References
 Clinical Procedures in Emergency
Medicine, Roberts and Hedges, 4th edition,
2004
 Clinician’s Pocket Reference, Leonard
Gomella, 8th edition, 1997
 Atlas of Human Anatomy, Frank Netter, 2nd
edition, 1997

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