CVP-Central venous catheter Placement using seldinger’s techniques

The procedure mainly used for the CVP-continuous central venous pressure monitoring and for purpose of the fluid management, drug therapy etc. central venous catheter is placed either in the internal jugular vein or subclavian vein, femoral vein, axillary vein.

Indication

Infusion and fluid volume therapy

Patients requiring CVC for

Hemodynamic monitoring

Administration of special medications – vasopressors, antibiotic drugs, correction of
electrolytes, chemotherapy etc

Access in patients where peripheral access is not possible
Total parenteral nutrition

For the administration of the high osmolarity solution

Intermittent central venous pressure monitoringCentral venous catheter

for venous blood sampling

for the no peripheral venous access

patients with injured extremities

for the shock patients

Material used

Seldinger needle or valve needle

Guidewire with length marking flexible J- tip /straight tip

Scalpel  11 sizes with BP handle

Dilator

Double lumen /triple lumen made of an opaque catheter made of polyurethane with a soft tip

With valves and three-way adapters

Colour coded Luer lock connection

Fixation wings for fixing the catheter

Luer lock syringe

Ultrasound sterile jelly

Drapes for the site (center hole )/normal drape

Tegaderm /condom or sterile gloves for the ultrasound probes

Drape for the ultrasound cable

Sterile solution for the skin preparation and alcohol-based disinfectant.

The appropriate size of suture for the catheter  fixation

Tegaderm dressing or custom dressing for the CVP

Colour coding used in the CVP

Yellow color – CVP monitoring

Red color

White color

Blue color

Procedure:

The site chosen for insertion would depend on the clinical situation. Although subclavian lines are superior in terms of incidence of catheter-related bloodstream infections, in an unstable patient, it is preferable to use the internal jugular vein because of the higher probability of serious complications with the subclavian route.

If there is a likelihood of severe coagulopathy or very low platelet count, (before these parameters are known) the femoral site may be used.
Central line insertion is very rarely done as an emergency procedure – if you need to use inotrope/vasopressor for support of blood pressure, it is OK to use a peripheral IV line.

so, until you are able to get central access. Remember, stabilization of the patient is a priority -line insertion is not. Hence, a CVC should not be inserted without taking appropriate aseptic precautions. Do seek help from senior colleagues if you are not sufficiently experienced with the procedure

Contraindications

Inflammation of the skin at the site of puncture anatomical anomaly

Very severe pulmonary emphysema

Postoperative changes in the site area

Risks

Hematoma at the site of puncture

Catheter sepsis

Pneumothorax or chylothorax

Haemothorax

Infusion hydrothorax

Incorrect catheter positions

Cardiac arrhythmias due to the incorrect intracardiac placement of the catheter

Arterial rupture

Endocarditis due to mechanical irritation

Arterial injuries due to incorrect puncture

Catheter-induced thrombosis

Thromboembolism

Thrombophlebitis of superior vena cava

Thoracic duct injuries

Damage to brachial plexus

Damage to the phrenic nerve

Warning

Do not reuse the single-use materials

Use strictly aseptic precaution & techniques for the CVP.

Use the position of the patients in Trendelenburg

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