Safety Committee of Japanese Society of Anesthesiologists.Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. The distal end of the catheter should be cranial to the tracheal bifurcation on CXR. Consult interventional radiology for retrieval. ![]() Avoid withdrawing the guidewire through the TWN.Hold the guidewire with nondominant hand at all times during catheter and introducer exchanges required by the Seldinger technique.If unable to pass the guidewire, remove the guidewire and needle as a single unit.Do not use force to overcome resistance.Withdraw the catheter an appropriate distance using sterile technique and resecure.Obtain CXR to verify the final location of the catheter.Do not exceed the recommended/calculated depth for catheter insertion.Persistent dysrhythmias: Remove the guidewire and begin ACLS as needed.In most cases, the procedure can continue.Withdraw the guidewire until rhythm returns to baseline.Do not advance the guidewire beyond 15–20 cm.Ensure that the cardiac monitor is visible and audible to identify ectopy early.Catheter placed in the carotid artery: Leave in place pending surgical consultation.Needle puncture only: Remove the needle and hold pressure.Identify the location with the greatest separation between the IJV and carotid artery.Use real-time ultrasound for line placement.Perform a preprocedure scan to identify the best cannulation site.Ĭommon pitfalls in internal jugular vein central line placement Hold the guidewire at all times when performing steps according to the Seldinger technique. Secure the catheter to the skin and apply a sterile dressing.Remove the guidewire, aspirate blood from all ports, and flush each port with saline.Remove the dilator and advance the catheter ∼ 16 cm (right IJV) or ∼ 20 cm (left IJV) over the guidewire.Thread the vascular dilator over the guidewire and advance 5–7 cm in a spiral motion into the vein.Make a small skin incision over the guidewire.Remove the needle while holding the guidewire in place.Feed 15–20 cm of guidewire through the needle.Hold the needle firmly and remove the syringe.Apply negative pressure to the syringe plunger and advance the needle until blood flashback occurs.Place the needle beneath the center of the probe at a 45° angle to the skin.This approach uses a thin wall needle (referred to as “needle” from here on) and the Seldinger technique. Tunneled CVLs for long-term use nontunneled CVLs for short-term use.Hemodialysis catheters: can be a long-term CVL or a short-term CVL.Long-term CVLs: e.g., PICC lines, tunneled CVLs, surgically implantable catheters.Sheath introducer (large gauge): used for rapid or high-volume fluid administration, or to aid insertion of other lines (e.g., Swan-Ganz catheter).Small gauge: decreases the risk of vessel thrombosis.Single-lumen CVL: 1 channel allows administration of a single solution at a given rate.Double-lumen CVL: 2 channels typically large gauge that allows high rates of fluid exchange, e.g., for hemodialysis or plasmapheresis.Triple-lumen CVL: 3 channels allows simultaneous administration of multiple solutions at different rates.Short-term CVLs: nontunneled CVLs typically intended to remain in place ≤ 14 days.Higher risk of pneumothorax than IJ line.Enters below the left or right clavicle via the subclavian vein.Higher risk of infection than subclavian line.Lower risk of pneumothorax than subclavian line insertion.Enters the neck via the left or right IJV.DefinitionĬomparison of CVLs by insertion site Complications include arterial puncture, pneumothorax, bloodstream infections, and venous thrombosis. Insertion is most commonly performed using the Seldinger technique and usually occurs under ultrasound guidance. The internal jugular vein is frequently chosen for central line placement because it is easy to access and is associated with fewer procedural adverse events than other sites. Smaller gauge, multiple-lumen catheters are used for prolonged fluid and medication administration. Large-gauge, single-lumen catheters are used for the rapid administration of fluid or blood products. ![]() The type of catheter used and anatomical location of placement are based on the patient's condition or injury and comorbidities. It also allows for specialist interventions such as advanced hemodynamic monitoring, transvenous pacing, and hemodialysis. Placement of a catheter in a large, central vein provides reliable venous access in patients who are critically ill, have poor venous access, and/or require administration of vesicants, irritant solutions, or large volumes of fluid.
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