Clin Skills 3 Venous Cannulation Flashcards
2 mc veins most commonly Accessed in IV lines:
Cephalic
Basilic
3 veins for IV line in <1 year old
veins of scalp:
Superior temporal
Posterior auricular
Frontal
Phlebitis/Thrombophlebitis/cellulitis
Tx of Chemical/mechanical, bacterial
warm compressions
antibiotics
Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from
other arm if possible
Otherwise, satisfactory samples may be drawn below the IV by following these procedures:
Turn off the IV for at least 2 minutes before venipuncture.
Apply the tourniquet below the IV site.
Select a vein other than the one with the IV.
Perform the venipuncture.
Draw 5 ml of blood and discard before drawing the specimen tubes for testing.
Central Venous Catheterization Indications (9)
for those whose volume status needs to be managed closely:
Central venous pressure monitoring
Acute Volume resuscitation
Cardiac arrest
Lack of peripheral access
Infusion of hyperalimentation
Infusion of concentrated solutions (chemo)
Placement of transvenous pacemaker
Cardiac catheterization, pulmonary angiography
Hemodialysis
flow rate through a 14 gauge peripheral line is twice that of a __ gauge central venous catheter
16
The 2 types of catheters
Cordis – singular large lumen
can be placed much quicker than TLC.
can replace large amounts of fluid in short amounts of time. Short and fat lumen.
1L of fluid in 1 minute
for GI bleed, trauma, burn patients fluid resuscitation
TripleLumenCatheter – for patients requiring multiple medications (IV pressors, antibiotics)
ideal for septic patient.
not for volume resuscitation. Ex: not for GI, trauma patient.
What’s the IV technique called?
Seldinger technique
What must you do post-line resplacement?
chest x-ray to review it.
3 mc places for central venous line
internal jugular -
femoral - no risk of pneumothorax, preferred site for emegencies & CPR, but highest risk of infxn. not good for ambulatory patients.
subclavian - most comfortable for conscious patients. But highest risk of pneumothorax, don’t do on intubated patients. Vein is non-compressible
Subclavian Approach to central line
Positioning:
Right side preferred
Supine position, head neutral, arm abducted
Trendelenburg (10-15 degrees) - reduces incidence of air embolism
Shoulders neutral with mild retraction
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
Catheter tip should terminate in the:
Catheter tip must never rest within the:
superior vena cava
right atrium
Femoral Approach
Positioning Supine - The more distal you are from the inguinal ligament, the closer the vein is to the artery as the femoral vein begins to dive behind the artery and the saphenous vein comes off the femoral vein. Needle placement Medial to femoral artery 2 cm below inguinal ligament Needle held at 45 degree angle Aim toward umbilicus
__ It is generally inserted as a last resort for emergent venous access.
Femoral central venous catheter
