C V C Presentation
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Lecture in icu King Saud Hospital
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C V C Presentation
- 1. Central Venous Catheterization By: Ms. Adnan A. Tander ICU- Staff Nurse
- 10. PREVENTION TREATMENT CLINICAL MANIFESTATION COMPLICATIONS -Proper patient preparation -Proper patient positioning -Sedation as necessary -Adequate hydration status -Proper patient preparation -Proper patient positioning -Sedation as necessary -Adequate hydration -Reduction of PEEP < 5cmH 2 O at time of venipuncture -Proper patient preparation -Proper patient positioning -Sedation as needed -Adequate hydration status -Confirmation by chest x-ray -Symptomatic treatment -Small pneumothorax: *bed rest, Oxygen -Peumothorax >25% *chest tube *C ardiopulmonary support -Treatment must be rapid and aggressive -Immediate air aspiration followed by chest tube -Cardiopulmonary support -Confirmation by chest x-ray -Chest tube -Cardiopulmonary support -Sudden respiratory distress -Chest pain -Hypoxia/cyanosis -Decreased breath sounds -Resonance to percussion -Most likely to occur in patients on ventilatory support -Respiratory distress -Cyanosis -Venous distension -Hypotension -Decreased cardiac output -Slow onset of respiratory symptoms -Subcutaneous emphysema -Persistent chest pain or back pain PNEUMONTHORAX TENSION PNEUMOTHORAX DELAYED PNEUMOTHORAX
- 13. PREVENTION TREATMENT CLINICAL MANIFESTATION COMPLICATIONS -Proper patient positioning -Extreme caution in venipuncture -Extreme caution in venipuncture -Position the patient in a high Fowler’s position to allow gravity to correct jugular tip malposition -Repositioning of catheter with guide wire under fluoroscopy or new venipuncture -Catheter removal -Location of fragment on x-ray -Transvenous retireval of catheter fragment -Thoracotomy if indicated -Treatment must be rapid and aggressive -Stop infusions -Aspiration through the catheter -Emergency pericardio- centesis -Emergency thoracotomy -Aspiration of air -Pain in ear or neck -Swishing sound in ear with infusion -Sharp anterior chest pain -Pain in shoulder blade -Cardiac dysrythmias -No blood return on aspiration -Observation on chest x-ray -Cardiac dysrythmias -Chest pain -Dyspnea -Hypotension -Tachycardia -Retrosternal/epigastric pain, pleural effusion -Dyspnea, hypotension -Venous engorgement of face and neck -Restlessness, confusion -Paradoxical pulse -Cardiac arrest CATHETER MALPOSITION CATHETER EMBOLISM PERICARDIAL TAMPONADE
- 14. PREVENTION TREATMENT CLINICAL MANIFESTATION COMPLICATIONS -Extreme caution in venipuncture -Extreme caution in venipuncture -Avoid catheter exchange in veins with thrombosis -Strict aseptic technique during catheter insertion -Proper and adequate skin preparation -Emergency reintubation for punctured ETT cuff -Aspiration of air in mediastinum -Remove catheter if suspected brachial plexus injury -Chest x-ray -Lung perfusion scan -Cardiopulmonary support -Hot compression for 48 to 72 hours -Removal of catheter -Subcutaneous emphysema -Pneumomediastinum -Air trapping between the chest wall and the pleura -Respiratory distress with puncture of ETT cuff -Tingling/numbness in arm or fingers -Shooting pain down the arms -Paralysis -Chest pain, Dyspnea -Tachycardia, Coughing -Anxiety, Fever -Redness, tenderness, swelling along the course of the vein -Pain in the upper extremity or shoulder TRACHEAL INJURY NERVE INJURY PULMONARY EMBOLISM THROMBO-PHLEBITIS
- 18. Internal Jugular Central Approach
- 20. Femoral artery Femoral nerve Femoral Vein NAVEL
- 33. NURSE’S NOTES SAMPLE: 11/08/1432 (1000HR) – THE PATIENT HAS NO PERIPHERAL LINE ACCESS AND IN NEED OF INTRAVENOUS ACCESS DUE TO SEVERE SHOCK. SO, UNDER LOCAL ANESTHESIA, A 7 FRENCH, TRIPLE LUMEN CENTRAL VENOUS CATHETER WAS INSERTED BY DR. BASSAM TAHA AT THE RIGHT SUBCLAVIAN AND SUTURED IN PLACE AT LEVEL 15 CM. THE AREA WAS CLEANED AND DRESSING (OPSITE) WAS APPLIED PROPERLY AND NEATLY. CHEST X-RAY WAS TAKEN AND SHOWING THE TIP OF THE CATHETER PROPERLY IN PLACE WITHIN THE SUPERIOR VENA CAVA. INITIAL CVP MEASURED 10 CM H2O. THE PATIENT TOLERATED THE PROCEDURE WITHOUT ANY COMPLICATIONS. VITAL SIGNS ARE STABLE WITH HR 75Bpm, RR 20 CYCLES/MIN, BP 120/80 mm Hg, SPO2 98% ON SIMV VENTILATORY SUPPORT, TPR 37.5 DEGREES CENTIGRADE. PRIOR TO THE PROCEDURE, CONSENT WAS SECURED.
- 36. Thank you!
Editor's Notes
- Basic materials section involves going through an actual catheter kit with them and demonstrating technique
- Central venous pressure monitoring – for those whose volume status needs to be managed closely Volume loading – flow rate through a 14 gauge peripheral line is twice that of a 20cm 16 gauge central venous catheter Concentrated solutions – potassium chloride, hyperosmolar saline, chemo agents. Or vasoactive substances like epi, dopamine. All can cause tissue irritation or necrosis if extravasated in peripheral line
- Bleeding disorders – even with platelet counts <50,000, bleeding is uncommon and easily managed, in the absence of arterial puncture Distorted local anatomy – ultrasound may help
- Arm abduction flattens the deltoid bulge Trendelenburg reduces incidence of air embolism Shoulders – as the shoulder falls backward, the space between the clavicle and first rib narrows, making the subclavian vein less accessible Right side preferred – lower pleural dome and thoracic duct on left Junction of the middle and medial thirds of the clavicle – here the vein in just posterior to the clavicle and just above the first rib which acts as a barrier to the pleura.
- UNC preferred site – in the hospital manual
- NAVEL – N = nerve, A = artery, V = vein, E = empty space, L = lymphatics (must be read from right side of body, L is always medial. So it is spelled backwards from the left side approach
- Go over kits and demonstrate procedure with students