Central_Venous_Access

Central_Venous_Access - Central Venous Access Module Vic V....

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Central Venous Access Module Vic V. Vernenkar, D.O. Dept. of Surgery St. Barnabas Hospital
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Approach Two approaches are commonly used and will be described: 1.Right internal jugular vein 2.Right sublclavian vein
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Indications Measurement of central venous pressure (CVP) insertion of a pulmonary artery catheter or transvenous pacemaker administration of fluids and medications, e.g.,if there is no peripheral access administration of hyperalimentation solutions or other fluids that are hypertonic and damage peripheral veins (such as Amphotericin B)
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CONTRAINDICATIONS Coagulopathy Infection over site of insertion Distortion of landmarks SVC syndrome Patients unable to cooperate or tolerate Trendelenberg positioning Pneumothorax on opposite side Patients with high end-expiratory pressures on mech. ventilation
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EQUIPMENT NEEDED Commercially available set containing needles, wires, sheaths, dilators, etc Needles, syringes, local anesthetic, 0.9% saline (may be heparinized with 1ml 1 in 100 heparin in 10ml 0.9% saline) Sterile gown, mask, gloves
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RIGHT INTERNAL JUGULAR VEIN APPROACH Three sites are described: 1. anterior - medial to the sternocleiodomastoid muscle 2. middle - between the two heads of sternocleidomastoid 3. posterior - lateral to the sternocleidomastoid The middle is the commonest and is the one described here. Patient discomfort when turning the head is the disadvantage of this technique
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Jugular Approach
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Procedure 1.Sterilize the site and drape with sterile towels 2.Administer the local anesthetic
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Procedure 1.Whilst this is working flush all the ports of the catheter with sterile 0.9% saline 2.Put the patient in the Trendelenburg position (i.E.Head down)
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Central_Venous_Access - Central Venous Access Module Vic V....

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