Name: Legen eines zentralen Venenkatheters (Englisch)
Uploaded: 2011-12-13T12:50:13+01:00
Duration: 4 min 17 s
Channel: Georg Graf von Westphalen
Description: Unter einem zentralen Venenkatheter versteht man einen in eine größere Körpervene eingeführten Katheter, über den man intravenös Medikamente und Infusionen zuführen oder den zentralen Venendruck messen kann. How to...

Legen eines zentralen Venenkatheters (Englisch)Unter einem zentralen Venenkatheter versteht man einen in eine größere Körpervene eingeführten Katheter, über den man intravenös Medikamente und Infusionen zuführen oder den zentralen Venendruck messen kann.How to insert a central venous catheter line.IJ venipuncture technique

Measure length of insertion of CVL catheter such that the tip will be at the level of the SVC

Identify the triangle formed by the clavicle and the 2 heads of the sternocleidomastoid muscle

Test and fill tubing lumens of catheter with saline

Anesthetize the skin at the superior aspect of this triangle

Locate the carotid pulse

Use finder needle to locate IJ (if the desision is amde to use finder needle, usually it is appropraite to go straight to lg-bore since the guidewire fits through it)

Direct the needle caudally at a 30-45 degree angle to the skin, parallel and lateral to the carotid artery
Maintain negative pressure on the syringe

If the IJ is not located at a depth of 3-5 cm, the needle should be withdrawn to just under the skin surface, then redirected slightly laterally

When venous blood is aspirated, withdraw the finder needle and insert Seldinger needle along the same path

Seldinger technique

Upon return of venous blood, detach syringe from needle and occlude the needle hub with thumb

Insert guide wire into needle and advance until 10-20 cm of wire remains uninserted

Hold the end of the wire with one hand while withdrawing the needle with other hand

Using a No. 11 scalpel, make a small incision where the wire enters the skin to facilitate catheter passage

Advance the catheter introducer over the wire to dilate the soft tissue and opening in the vein; take care to continue to hold the end of the wire with one hand

Remove the catheter introducer while keeping the wire in place

Advance the CVL catheter over the wire (and partly withdraw the wire if necessary) until the wire is visible at the catheter hub

The catheter should be advanced to the desired depth

Withdraw the wire

Post proceedure

Inspect site for hematoma

Aspirate catheter hub(s) with syringe to check for free flow of venous blood; it is important to minimize contact with for risk of an embolus; if time allows, fill ports with saline before procedure

Attach IV catheter; flush bllod out of ports if multiple lumen

Suture the CVL catheter in place and apply a sterile dressing

Ausculate lungs

Confirm placement with post-procedure CXR

Source: www.pocketsnips.org