Central venous catheterisation

CENTRAL VENOUS CATHETERISATION AND CENTRAL VENOUS PRESSURE

IRENE ROSE JOY

Central venous catheter

• Central venous access is the placement of a venous catheter in a vein that leads directly to the heart.

Types of central venous catheters

• Non tunneled central catheters
• Tunneled central catheters
• Peripherally inserted central catheters (PICC)
• Implantable Ports

• non tunneled//////

tunneled/////

• 2 fotos

• picc////
• 2 fotos

• subcut////
• 2 fotos

Indications

• Central venous pressure monitoring
• Volume resuscitation
• Infusion of concentrated solutions
• Placement of transvenous pacemaker
• Cardiac catheterisation and pulmonary angiography
• Temporary hemodialysis
• Lack of peripheral access.

Relative contraindications

• Bleeding disorders
• Anticoagulation or thrombolytic therapy
• Distorted local anatomy
• Cellulitis, burns, severe dermatitis at site
• Vasculitis

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

Catheterisation kits

Basic Principles

• decide if line is really necessary
• know the anatomy
• be familiar with the equipment
• obtain optimal patient positioning and coperation
• take your time
• use sterile technique
• always have a hand on the wire
• ask for help
• always aspirate as you advances,as you withdraw the needle slowly
• always withdraw the needle to the level of the skin before redirecting the angle
• obtain chest xay, post line placement and review it.

LOCATION
Internal Jugular
Femoral
Subclavian
ADVANTAGES

• Bleeding can be recognised and controlled
• Malposition is rare
• Less risk of pneumothorax
• Easy to find vein
• No risk of pneumothorax
• Preferred site for emergencies and CPR
• Fewer bad complications
• Most comfortable for conscious patients

DISADVANTAGES

• Risk of carotid artery puncture
• Highest risk of infection
• Risk of DVT
• Not good for ambulatory patients
• Highest risk of pnuemothorax, preferable not to do on intubated patients
• should not be done if <2years
• Vein is noncompressible