Healthcare and Medicine Reference
In-Depth Information
Step-by-step guide: right internal jugular central
venous access
Give a full explanation to the patient in simple terms and
ensure they consent to the procedure (if able).
Set up your trolley (Box 11.1 and Figure 11.3).
Ensure the pressurised monitoring system is set up.
Prepare your trolley as a sterile fi eld. Wear a plastic
disposable apron and non-sterile gloves, and take alcohol
hand rub with you.
1
After setting up the trolley, discard gloves and apron used,
re-wash hands and don a new pair of non-sterile gloves and
apron.
Before putting on sterile gloves, position the patient. The
(a)
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patient should be on a trolley which can be tipped head down
(Trendelenberg position) and the area should be exposed,
whilst maintaining as much dignity as possible. Positioning the
patient correctly is the key to success (Box 11.2). A head-down
position should be used when cannulating to minimise the risk
of venous air embolism.
Scrub and wear a sterile gown, gloves and a facemask. Consider
3
eye protection. You will need an assistant to help to fi nalise your
preparations, talk to the patient and go for help should prob-
lems arise.
Ask your assistant to pour saline into your Gallipot. Attach
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three-way taps to all but the central lumen and fl ush each line
with saline. Turn the taps to the closed position. Place the line
back onto the draped trolley.
Clean the skin with antiseptic (2% chlorhexidine in 70% isopropyl
(b)
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alcohol is recommended) and drape the area (Figure 11.4a,b).
A sterile technique should be maintained throughout insertion
and securing the central line.
Figure 11.3 Equipment required for central venous cannulation.
(a) Correctly prepared trolley, which includes the components of a
commercially available central line kit, drapes, cleaning solution, ultrasound
probe cover and dressings. (b) A typical three-lumen central line with
three-way taps attached.
Box 11.1 Equipment for central venous cannulation
Box 11.2 Patient positioning
Central line kit containing:
needle or a cannula over needle
Internal jugular
The patient should be lying as fl at as possible with the head
resting on one pillow and turned to look to the contralateral
side. The trolley should be tipped head down to about 15°, the
Trendelenburg position, which distends the veins and decreases the
risk of air embolism. Place a large absorbent pad under the patient's
head and shoulders to protect the bedclothes from cleaning fl uid
and blood.
central venous catheter
guidewire
dilator
Additional items:
suture
anchoring clips.
scalpel
appropriate dressing
Subclavian
As for IJ except that a pillow should be placed under the upper back
and the head allowed to fall backwards onto the bed rather than
onto the pillow.
syringes
blue and green needles
three-way taps, one for each lumen
drapes
cleaning fl uid (2% chlorhexidine gluconate in 70% isopropyl
Femoral
Place the patient fl at, and abduct the leg to about 30°, or even let
the leg hang over the side of the bed.
Identify the femoral artery and vein and ensure that an imaginary
line passing through the femoral vein to the iliac veins and onto the
inferior vena cava is approximately straight.
alcohol is recommended)
swabs
Gallipot or similar
sterile ultrasound probe sheath
0.9% normal saline.
 
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