Views:2 Author:Site Editor Publish Time: 2021-07-23 Origin:Site
Central venous catheter is a type of intravascular tube, which is placed in a large vein. The choice of central venous catheter puncture method depends on the doctor's personal habits, proficiency and puncture equipment. For puncture of the internal jugular vein and subclavian vein, the head is generally placed in a supine position with the head lowered 15°, a thin pillow is placed under the shoulder, and the head is turned to the opposite side. The right side is more profitable than the left side. Next, the editor of Zibo Dongmai will share with you the method of puncture of the central venous catheter.
1. Internal jugular vein
With the sternocleidomastoid muscle as a mark, there are three methods of anterior, middle and posterior approach. Advance: The surgeon uses the left index finger and middle finger to open 3cm beside the midline, at the midpoint of the front edge of the sternocleidomastoid muscle, which is equivalent to the level of the upper edge of the thyroid cartilage. Touch the common carotid artery and push it to the inside, away from the common carotid artery. Insert the needle at 0.5 cm from the outer edge of the pulsation. The needle body and the skin are at an angle of 30°-40°, and the needle tip points to the triangle of the sternocleidomastoid muscle. The needle is inserted and withdrawn. After the dark red blood is seen, the tube is placed securely. Middle approach: Take the triangle vertex of the sternocleidomastoid muscle as the needle entry point, which is 3 to 5 cm from the upper edge of the clavicle (about 1 to 2 transverse fingers), and the angle between the needle body and the skin is 30°, parallel to the midline. The lateral nipple, usually 2 to 3 cm into the internal jugular vein. Posterior approach: Insert the needle at the middle and lower 1/3 intersection of the outer edge of the sternocleidomastoid muscle, keep the needle body level, and point the needle to the upper fossa of the sternum manubl.
2. Subclavian vein
With the clavicle as a mark, it is divided into upper and lower two approaches. Supraclavian approach: Insert the needle at the lateral edge of the clavicle head of the sternocleidomastoid muscle, about 1.0 cm above the clavicle. The needle body is at an angle of 45° to the sagittal plane and the clavicle, and is horizontal or slightly forward in the coronal plane. ° Angle, the tip of the needle points to the sternoclavicular joint, generally 1.5 to 2 cm into the subclavian vein. Subclavian approach: The traditional approach is to insert the needle from the junction of the middle and inner 1/3 of the clavicle, 1 to 1.5 cm from the lower edge of the clavicle, with the needle tip pointing to the posterior upper edge of the ipsilateral sternoclavicular joint. The best puncture point is the intersection of the vertical line of the center of the right clavicle and the horizontal line of the sternoclavicular joint for the modified new approach. The tip of the needle points to the lower edge of the thyroid cartilage.
3. Femoral vein
At the two transverse fingers under the inguinal ligament, touch the femoral artery with the index finger and middle finger of the left hand, and insert the needle 0.5cm inside of it, with the needle tip pointing to the head, and the needle body and the skin at a 30° angle. In clinical practice, the author prefers to use the "three-position method" to determine the location of femoral vein puncture. The positioning method is simple and accurate.
4. Methods and materials
Routinely disinfect the puncture site. After 2% procaine is locally anesthetized, first try to return the blood with a disposable syringe, then introduce the central venous catheter puncture needle in the original direction, keep the negative pressure and slowly insert the needle and withdraw the blood. Later, fix the needle with the left hand and introduce the guide wire with the right hand to the proper length, then withdraw the needle while inserting the guide wire, expand the subcutaneous dilator, insert the deep venous catheter through the guide wire, and connect the three-way infusion device. The catheter was sutured with three needles in a semicircular shape.
The above is the method of central venous catheter puncture. Central venous catheter is the way to give long-term parenteral nutrition, long-term antibiotic injection, long-term painkiller injection, and can also be used for hemodialysis and tumor chemotherapy. It can establish a good blood channel for patients with repeated infusions and avoid the pain of repeated punctures.