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Figure 11.4 Step-by-step guide: central venous access. (a) Sterilising
insertion site with a commercially available preparation of 2% chlorhexidine
gluconate in 70% isopropyl alcohol. (b) Patient draped with 'aperture'
sterile drape. (c) Using a draped US probe to identify insertion landmarks.
(d) Infi ltrating local anaesthetic (1% lidocaine) around identifi ed insertion
site. (e) Aspirating blood from internal jugular. (f) Using wire introducer.
(g) Guidewire inserted through needle. (h) Guidewire in situ. (i) Cutting
down onto wire with scalpel. (j) Dilating over guidewire. (k) Inserting central
line over guidewire. (l) Ensuring guidewire is securely held as central line
is introduced. (m) Line inserted to 15 cm depth. (n) Aspirating all ports of
line (fl ashback can be clearly seen). (o) Placing secure clips over wire. (p)
Clips sutured into position to secure wire. (q) Line dressed clearly showing
insertion site.
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