Beruflich Dokumente
Kultur Dokumente
APPENDIX: I
II. INDICATIONS:
1. Rapid fluid replacement for traumatic exsanguination
2. To gain venous access in the presence of symptomatic
hypotension and venous collapse
III. CONTRAINDICATIONS:
IV. COMPLICATIONS:
1. Hemotoma with airway compromise
2. Inadvertent extravenous placement causing:
• pneumothorax
• hemothorax
• hydrothorax
• hydromediastinum
3. Major vessel laceration of the:
• femoral artery
• subclavian artery
• carotid artery
4. Air embolus
5. Sepsis
V. PROCEDURE:
I Femoral approach
Special Considerations: Medications given via the femoral route in second
and third trimester may not be distributed effectively. Consider other sites.
Procedure
and blood return when the infusion set is lowered below the level of
the patient’s heart.
7. Secure the catheter and place an occlusive dressing over the
insertion site.
Care should be taken when accessing the internal jugular vein because of the
proximity of adjacent structures.
Procedure
Subclavian approach
1. Prepare equipment in advance.
2. Place the patient in the Trendelenburg position with the face rotated
away from the side of insertion.
3. Identify the anatomical landmarks, specifically the clavicle and the
suprasternal notch.
4. Using aseptic technique, prepare the insertion site.
5. Establish a point of reference by placing a fingertip into the
suprasternal notch to locate the deep side of the superior aspect of
the clavicle.
6. Using a long 14 or 16-gauge over-the-needle catheter with an
attached 10-12 cc syringe, introduce the needle approximately 1 cm
below the junction of the middle and medial thirds of the clavicle.
7. Apply negative pressure to the syringe and direct the insertion
medially and slightly cephalad toward the posterior and superior
Special Considerations
Arterial bleeding will result if the needle is dislodged from a dialysis graft or
fistula.
Dialysis fistulas and grafts (located under skin of arm) may have high back
pressure and require positive pressure to infuse.
When attempting to insert a needle into a dialysis fistula, avoid the scar line
or any lumpy areas in the graft or fistula. Follow the track marks that are
present from previous use of the site for dialysis.
When in doubt, aspirate first PRIOR TO FLUSHING the line. The heparin
in some catheters is an extremely high concentration that will be
harmful if it enters central circulation.
APPENDIX
I
Devices
I
(This Page Left Blank)
CENTRAL VENOUS ACCESS