Central venous catheterisation

USG guided Central venous access

• Vein is accessed under direct visualisation
• Helpful in patients with difficult anatomy
• Vein is compressible
• vein is not always larger

usg//// femoral

When to act

• Temp of 100.5F or greater
• Chills, dyspnoea, dizziness
• Pain, redness, swelling or drainage at site
• Unresolved resistance, pain or fluid leaking while flushing
• Hole or tear in catheter
• Excessive bleeding at site
• Change in length of external catheter
• Swelling in neck, face, chest or arm

Complications

• Vascular
• Air embolus
• Arterial puncture
• Ateriovenous fistula
• Hematoma
• Blood clot
• Infectious
• Sepsis, cellulitis, osteomyelitis,septic arthritis
• Miscellaneous
• Dysrhythmias
• Catheter knotting or malposition
• Nerve injury
• Pneumothorax, hemothorax,hydrothorax, hemomediastinum

Discontinuing a CVC

• Follow the institution's policy and procedure
• Remove catheter and apply pressure dressing over a petroleum gauze
• Check catheter to ensure the tip is intact.
• Document

Central venous pressure

• Central Venous Pressure (CVP) describes the pressure of blood in the vena cava, near the right atrium of the heart.
• Normal values: 0-14cm H2O at level of sterum

8-15cm H2O at mid axillary line

• CVP monitoring helps :
• assess cardiac function
• evaluate venous return to the heart
• to indirectly know how well the heart is pumping
• 1.To measure the patient's volume status, a disposable plastic water manometer is attached between the IV line and the central catheter with a three or four way stopcock
• 2. Measurement using transducer.