Central Venous Catheterisation

CENTRAL VENOUS CATHETERISATION

 

Internal jugular vein approach (Seldinger's technique)

Position of patient 

Patient should be in head low position with head turned to face the left.

Procedure 

1. Skin is cleaned with antiseptic. Neck can be extended by keeping a rolled towel or normal saline bag under shoulder.

2. Local anaesthesia may be infiltered but that causes a wheal production which may hide the puncture site.

3. Right internal carotid artery is palpated lateral to cricoid cartilage. 

4. Triangle formed by two heads of sternocleidomastoid muscle and clavicle is located.  

5. The heparinised needle with the syringe attached is inserted starting at the apex of the triangle keeping fingers gently over the internal carotid artery just lateral the pulsations at an angle 30 to 40 degree to the skin and advancing it downward in the direction of nipple on same side. 

Another way to gain access to IJV is to go behind the posterior head of sternocleidomastoid. 

6. Blood is aspirated to confirm that needle is in the lumen of vein.

7. The guide wire is threaded through needle into vein with J shaped end first.

8. Needle is then removed.

9. Dilator is passed over guide wire in the twisting motion to dilate the site of skin puncture. A small incision in the skin may be necessary to introduce the dilator.
   
   
   

10. Dilator is removed and catheter is passed over guide wire.  

11. Guide wire is removed. 

    

12. After confirming blood can be aspirated freely the catheter is flushed properly with heparinised saline.

    

13. The catheter is secured in place with suture and sterile dressing is given. 

 

    •     Post procedure X ray Chest is taken for confirming the position of the central line 

For accurate CVP measurement, the tip of the central venous catheter (CVC) should lie within the superior vein cava (SVC), above its junction with the right atrium and parallel to the vessel walls.

Other Sites  

1. Subclavian Vein 

2. Antecubital Vein 

3. Femoral Vein 

Written by our guest author - Akash Davhale

Illustrations by Devi Bavishi

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