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If the IJ is not located at a depth of 3-5 cm, the needle should be withdrawn to just under the skin surface, then redirected slightly laterally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