Angina

Catheterization of veins - central and peripheral: indications, rules and algorithm for catheter installation. Catheterization of the central veins Catheterization of the great vessels according to Seldinger

The patient's position is horizontal with a cushion placed under the shoulder girdle ("under the shoulder blades"), 10-15 cm high. The head end of the table is lowered by 25-30 degrees (Trendelenburg position).

Preferred side: right, since the thoracic or jugular lymphatic ducts can flow into the terminal section of the left subclavian vein.

Anesthesia is performed

The principle of central venous catheterization is laid down Seldinger (1953).

The puncture is carried out with a special needle from a set for catheterization of central veins, mounted on a syringe with a 0.25% novocaine solution. (a needle 15 cm long or more with sufficient thickness

The doctor performing the manipulation limits the needle with his finger at a distance of 0.5-1 cm from its tip. This prevents the needle from inserting deeply into the tissue uncontrollably when significant force is applied when piercing the skin.

The needle is inserted 1 cm below the clavicle at the border of its medial and middle third (Aubanac's point). The needle should be directed towards the postero-superior edge of the sternoclavicular joint or, according to V.N. Rodionova (1996), to the middle of the width of the clavicular pedicle of the sternocleidomastoid muscle, that is, somewhat laterally. As a result, the vessel is punctured in the area of the venous angle of Pirogov. Advancement of the needle should be preceded by a stream of novocaine.

After puncturing the subclavian muscle with a needle (a feeling of failure), the piston should be pulled towards you, moving the needle in a given direction (a vacuum can be created in the syringe only after releasing a small solution of novocaine to prevent clogging of the needle lumen with tissue). After entering the vein, a trickle of dark blood appears in the syringe and the needle should not be advanced further into the vessel due to the possibility of damage to the opposite wall of the vessel with subsequent exit of the conductor there. If the patient is conscious, he should be asked to hold his breath while inhaling (prevention of air embolism) and through the lumen of the needle removed from the syringe, insert a fishing line guide to a depth of 10-12 cm, after which the needle is removed, while the guide sticks and remains in the vein . Then the catheter is advanced along the guidewire with a clockwise rotational movement to the previously specified depth.

After this, the guidewire is removed, a heparin solution is injected into the catheter and a plug cannula is inserted. To avoid air embolism, the catheter lumen should be covered with a finger during all manipulations. If the puncture is unsuccessful, it is necessary to withdraw the needle into the subcutaneous tissue and move it forward in a different direction (changes in the direction of the needle during the puncture process lead to additional tissue damage). The catheter is fixed to the skin

Technique of percutaneous puncture and catheterization of the subclavian vein using the Seldinger method from the supraclavicular approach

Position of the patient: horizontal, there is no need to place a cushion under the shoulder girdle (“under the shoulder blades”). The head end of the table is lowered by 25-30 degrees (Trendelenburg position). The upper limb on the puncture side is brought to the body, the shoulder girdle is lowered, with the assistant pulling the upper limb down, the head is turned in the opposite direction by 90 degrees. In case of a serious condition of the patient, the puncture can be performed in a semi-sitting position.

The position of the doctor is standing on the puncture side.

Preferred side: right

The needle is inserted at the point Joffe, which is located in the angle between the lateral edge of the clavicular leg of the sternocleidomastoid muscle and the upper edge of the clavicle. The needle is directed at an angle of 40-45 degrees in relation to the collarbone and 15-20 degrees in relation to the front surface of the neck. As the needle is inserted, a slight vacuum is created in the syringe. Usually it is possible to enter the vein at a distance of 1-1.5 cm from the skin. A scaffold guide is inserted through the lumen of the needle to a depth of 10-12 cm, after which the needle is removed, while the guide sticks and remains in the vein. Then the catheter is advanced along the guidewire with screwing movements to the previously specified depth. If the catheter does not pass freely into the vein, its advancement can be facilitated by turning it around its axis (carefully). After this, the guidewire is removed and a plug cannula is inserted into the catheter.

Technique of percutaneous puncture and catheterization of the subclavian vein according to the “catheter through catheter” principle

Puncture and catheterization of the subclavian vein can be carried out not only according to the Seldinger principle (“catheter over a guide”), but also according to the “ catheter through catheter". Puncture of the subclavian vein is carried out using a special plastic cannula (external catheter) placed on a needle for catheterization of the central veins, which serves as a puncturing stylet. In this technique, the atraumatic transition from needle to cannula is extremely important, and, as a result, low resistance to passing the catheter through the tissue and, in particular, through the wall of the subclavian vein. After the cannula with the stylet needle has entered the vein, the syringe is removed from the needle pavilion, the cannula (external catheter) is held, and the needle is removed. A special internal catheter with a mandrel is passed through the external catheter to the required depth. The thickness of the internal catheter corresponds to the lumen diameter of the external catheter. The external catheter pavilion is connected using a special clamp to the internal catheter pavilion. The mandrin is removed from the latter. A sealed lid is placed on the pavilion. The catheter is fixed to the skin.

INDICATIONS for catheterization may include:

Inaccessibility of peripheral veins for infusion therapy;

Long operations with large blood loss;

The need for large volumes of infusion therapy;

The need for parenteral nutrition, including the transfusion of concentrated, hypertonic solutions;

The need for diagnostic and control studies to measure CVP (central venous pressure).

CONTRAINDICATIONS to PV catheterization are:

Superior vena cava syndrome:

Paget-Schroeter syndrome (acute thrombosis of the subclavian vein);

Sharp disturbances of the blood coagulation system towards hypocoagulation;

Local inflammatory processes at the sites of venous catheterization;

Severe respiratory failure with pulmonary emphysema;

Bilateral pneumothorax;

Injury to the clavicle area.

In case of unsuccessful CPV or its impossibility, internal and external jugular or femoral veins are used for catheterization.

The subclavian vein starts from the lower border of the 1st rib, goes around it from above, deviates inwards, downwards and slightly forward at the place of attachment to the 1st rib of the anterior scalene muscle and enters the chest cavity. Behind the sternoclavicular joint they connect with the internal jugular vein and form the brachiocephalic vein, which in the mediastinum with the same left side forms the superior vena cava. In front of the PV is the collarbone. The highest point of the PV is anatomically determined at the level of the middle of the clavicle at its upper border.

Laterally from the middle of the clavicle, the vein is located anterior and inferior to the subclavian artery. Medially behind the vein there are bundles of the anterior scalene muscle, the subclavian artery and, then, the dome of the pleura, which rises above the sternal end of the clavicle. The PV passes anterior to the phrenic nerve. On the left, the thoracic lymphatic duct flows into the brachiocephalic vein.

For CPV, the following medications are needed: novocaine solution 0.25% - 100 ml; heparin solution (5000 units in 1 ml) - 5 ml; 2% iodine solution; 70° alcohol; antiseptic for treating the hands of a doctor performing an operation; cleol. sterile instruments: pointed scalpel; syringe 10 ml; injection needles (subcutaneous, intravenous) - 4 pieces; needle for puncture catheterization of veins; surgical needle; needle holder; scissors; surgical clamps and tweezers, 2 pieces each; an intravenous catheter with a cannula, a plug and a guidewire corresponding to the thickness of the diameter of the internal lumen of the catheter and twice its length; container for anesthetic, pack with a sheet, diaper, gauze mask, surgical gloves, dressing material (balls, napkins).

Catheterization technique

The room where CPV is performed must be in a sterile operating room: dressing room, intensive care unit or operating room.

In preparation for CPV, the patient is placed on the operating table with the head lowered by 15° to prevent air embolism.

The head is turned in the direction opposite to the one being punctured, the arms are extended along the body. Under sterile conditions, a hundred is covered with the above instruments. The doctor washes his hands as before a normal operation and puts on gloves. The surgical field is treated twice with a 2% iodine solution, covered with a sterile diaper and treated again with 70° alcohol.

Subclavian access Using a syringe with a thin needle, 0.5% procaine solution is injected intradermally to create a “lemon peel” at a point located 1 cm below the clavicle on the line separating the middle and inner third of the clavicle. The needle is advanced medially towards the upper edge of the sternoclavicular joint, continuously applying procaine solution. The needle is passed under the collarbone and the rest of the procaine is injected there. The needle is removed with a thick sharp needle, limiting the depth of its insertion with the index finger, and the skin is pierced to a depth of 1–1.5 cm at the location of the “lemon peel”. The needle is removed. A syringe with a capacity of 20 ml is filled up to half with 0.9% sodium chloride solution, and a not very sharp (to avoid puncture of the artery) needle 7–10 cm long with a bluntly beveled end is put on. The direction of the bevel should be marked on the cannula. When inserting the needle, its bevel should be oriented in the caudal-medial direction. The needle is inserted into a puncture previously made with a sharp needle (see above), and the depth of possible needle insertion should be limited to the index finger (no more than 2 cm). The needle is advanced medially towards the upper edge of the sternoclavicular joint, periodically pulling the plunger back, checking the flow of blood into the syringe. If unsuccessful, the needle is pushed back without removing it completely, and the attempt is repeated, changing the direction of advancement by several degrees. As soon as blood appears in the syringe, part of it is injected back into the vein and again sucked into the syringe, trying to obtain a reliable reverse blood flow. If a positive result is obtained, ask the patient to hold his breath and remove the syringe from the needle, squeezing its hole with a finger. A conductor is inserted into the needle with light screwing movements halfway; its length is slightly more than two times the length of the catheter. The patient is again asked to hold his breath, the guide is removed, closing the catheter hole with a finger, then a rubber stopper is put on the latter. After this, the patient is allowed to breathe. If the patient is unconscious, all manipulations associated with depressurization of the lumen of the needle or catheter located in the subclavian vein are performed during exhalation. The catheter is connected to the infusion system and fixed to the skin with a single silk suture. Apply an aseptic dressing.

Complications with CPV

Incorrect position of the guidewire and catheter.

This leads to:

Heart rhythm disturbances;

Perforation of the vein wall, heart;

Migrations through veins;

Paravasal administration of fluid (hydrothorax, infusion into the fiber);

Twisting of the catheter and formation of a knot on it.

In these cases, correction of the position of the catheter, assistance from consultants, and possibly removal of it are required to avoid worsening the patient's condition.

Puncture of the subclavian artery usually does not lead to serious consequences if it is promptly identified by pulsating bright red blood.

To avoid air embolism, it is necessary to maintain the tightness of the system. After catheterization, a chest x-ray is usually ordered to rule out possible pneumothorax.

If the catheter is left in the PV for a long time, the following complications may occur:

Vein thrombosis.

Catheter thrombosis,

Thrombo- and air embolism, infectious complications (5 - 40%), such as suppuration, sepsis, etc.

To prevent these complications, it is necessary to properly care for the catheter. Before all manipulations, you should wash your hands with soap, dry them and treat them with 70° alcohol. To prevent AIDS and serum hepatitis, wear sterile rubber gloves. The sticker is changed daily, and the skin around the catheter is treated with 2% iodine solution, 1% brilliant green solution, or methylene blue. The infusion system is changed daily. After each use, the catheter is flushed with a heparin solution to create a “heparin lock”. It is necessary to ensure that the catheter is not filled with blood. The catheter is changed using a guide every 5 - 10 days to prevent complications. If such occurs, the catheter is removed immediately.

Thus, CPV is a rather complex operation, which has its own indications and contraindications. Due to the individual characteristics of the patient, violation of catheterization technique, omissions in caring for the catheter, complications may arise with harm to the patient, therefore, instructions have been created for all levels of medical personnel related to this (attending physician, team performing CPV, nurse in the manipulation room). All complications must be recorded and discussed in detail in the department.

Access to the PV can be either subclavian or supraclavicular. The first is the most common (probably due to its earlier implementation). There are many points for puncture and catheterization of the subclavian vein, some of them (named by authors) are shown in the figure

The Abaniak point is widely used, which is located 1 cm below the collarbone along the line dividing the inner and middle third of the clavicle (in the subclavian fossa). From my own experience, the point can be found (this is especially important in obese patients) if the second finger of the left hand (with CPV on the left) is placed in the suvarar notch of the sternum, and the first and third fingers slide along the lower and upper edges of the clavicle until the first finger hits the subclavian fossa. The needle for puncture of the PV should be directed at an angle of 45 to the clavicle into the projection of the sternoclavicular joint between the clavicle and the 1st rib (along the line connecting the first and second fingers); it should not be punctured deeper.

RECOGNITION OF ARTERY PUNCTURE AND PREVENTION OF AIR EMBOLISM.

In all patients with normal blood pressure and normal oxygen tension in the blood, arterial puncture is easily recognized by the pulsating stream and bright red color of the blood. However, in patients with profound hypotension or significant arterial desaturation, these signs may be absent. If there is any doubt about where the guide needle is located - in a vein or artery, a single-lumen number 18 catheter, available in most kits, should be inserted into the vessel through a metal guide. This step does not require the use of an extender. The catheter can be connected to a pressure transducer to identify the venous pulse wave and venous pressure. It is possible to take two identical blood samples at the same time to determine blood gases from the catheter and from any other artery. If the gas content is significantly different, the catheter is in the vein.

Patients with spontaneous breathing have negative venous pressure in the chest at the moment of inspiration. If the catheter is in free communication with outside air, this negative pressure can draw air into the vein, resulting in an air embolism. Even a small amount of air can be fatal, especially if it is transferred into the systemic circulation through an atrial or ventricular septal defect. To prevent such a complication, the mouth of the catheter must be closed at all times, and at the time of catheterization the patient must be in the Trandelenburg position. If an air embolism does occur, in order to prevent air from entering the outflow tract of the right ventricle, the patient should be placed in the Trandelenburg position with the body tilted to the left. To speed up air resorption, 100% oxygen should be prescribed. If the catheter is in the heart cavity, air aspiration should be used.

PREVENTIONAL PRESCRIPTION OF ANTIBIOTICS.

Most studies of prophylactic antibiotic use have shown that this strategy was associated with a reduction in infectious complications involving the bloodstream. However, the use of antibiotics is not recommended, since it promotes the activation of microorganisms sensitive to antibiotics.

Care of the manipulation site

OINTMENTS, SUBCUTANEOUS CUFFS AND BANDAGES

Applying an antibiotic ointment (eg, basithramycin, mupirocin, neomycin, or polymyxin) to the catheter site increases the incidence of fungal colonization of the catheter, promotes the activation of antibiotic-resistant bacteria, and does not reduce the number of catheter-related infections involving the bloodstream. These ointments should not be used. Likewise, the use of silver-impregnated subcutaneous cuffs does not reduce the incidence of catheter-related bloodstream infections and is therefore not recommended. Because evidence is conflicting regarding the optimal type of dressing (gauze versus clear materials) and the optimal frequency of dressing changes, evidence-based recommendations cannot be formulated.

Percutaneous catheterization femoral artery Seldinger performed using a special set of tools consisting of puncture needle, dilator, introducer, metal conductor with a soft end and catheter, size 4-5 F ( by French).

Modern angiographic machines are designed in such a way that punctures It is more convenient to use the right femoral artery. The patient is placed on his back on a special table for angiography and the right leg is brought to a state of maximum pronation.

The pre-shaved right groin area is lubricated with iodine, then wiped with alcohol and isolated with disposable sterile sheets to prepare a large sterile area for conductor And catheter.

Given the topographic anatomy of the femoral artery, it is necessary to locate the inguinal ligament and mentally divide it into three parts. The projection of the passage of the femoral artery is often located at the border of the middle and medial third of the inguinal ligament. Find her palpation, as a rule, there is no difficulty in its pulsation. It's important to remember that medially from the femoral artery is the femoral vein, and laterally- femoral nerve.

With the left hand, the femoral artery is palpated on the inner surface of the lower limb 2 cm below the inguinal ligament and fixed between the index and middle fingers.

The painfulness of the manipulation requires that the conscious patient be given infiltration anesthesia with a solution of novocaine or lidocaine.

After performing local anesthesia of the skin and subcutaneous tissue with a 1% lidocaine solution or a 2% novocaine solution, produce puncture femoral artery. puncture needle is introduced in the direction pulsations, at an angle not exceeding 45 degrees, which reduces the subsequent likelihood of excessive bending catheter.

Tilting the outer end needles to the skin, pierce the front wall of the vessel. But more often needle passes both walls at once, and then the tip needles enters the lumen of the vessel only when it moves in the opposite direction.

Igloo tilted even more towards the thigh, removed from it mandrin and insert the metal conductor, the tip of which is advanced into the lumen of the artery 10-15 cm in the central direction under Poupart's ligament. While carefully advancing the instrument, it is necessary to assess the presence of resistance. When positioned correctly needles in the vessel, there should be no resistance.

Further promotion conductor, especially in persons over 50 years of age, must be carried out only under X-ray control to the level of the twelfth thoracic vertebra (Th-12).

Fix through the skin with the index finger of the left hand conductor in the lumen of the artery, and igloo taken out. Pressing with a finger prevents extraction from the artery conductor and arterial blood seeping past it under the skin.

To the outer end conductor put on dilator, corresponding in diameter to the injected catheter. Dilator enter, moving along conductor 2-3 cm into the lumen of the femoral artery.

After removal dilator put on the conductor introducer, which is entered by conductor into the femoral artery.

At the next stage catheterization required at the outer end conductor put on catheter and by promoting it distally, enter into introducer and further into the femoral artery.

From the femoral artery catheter (from the Greek kathet?r - a surgical instrument for emptying a cavity) - a tube-shaped instrument intended for the introduction of drugs and radiopaque substances into the natural channels and cavities of the body, blood and lymphatic vessels, as well as for extracting their contents for diagnostic or therapeutic purposes . carried out along the vascular bed under radiographic control until aorta, after which conductor the catheter is removed and further advanced until target vessel carried out without it.

It should be remembered that after the procedure is completed, the place punctures must be securely pressed to the bone base to avoid hematoma.

External iliac artery (arteria iliaca external, femoral artery (arteria temoralis) and their branches. Front view.

1-common iliac artery;

2-internal iliac artery;

3-external iliac artery;

4-inferior epigastric artery;

5-femoral vein;

6-external genital arteries;

7-medial circumflex femoral artery;

8-femoral artery;

9-saphenous nerve;

10-lateral circumflex femoral artery;

11-deep femoral artery;

12-superficial artery, circumflex ilium;

13-inguinal ligament;

14-deep artery, circumflex ilium;

15-femoral nerve.

Patient position: horizontal, there is no need to place a cushion under the shoulder girdle (“under the shoulder blades”). The head end of the table is lowered by 25-30 degrees (Trendelenburg position). The upper limb on the puncture side is brought to the body, the shoulder girdle is lowered, with the assistant pulling the upper limb down, the head is turned in the opposite direction by 90 degrees. In case of a serious condition of the patient, the puncture can be performed in a semi-sitting position.

Doctor's position– standing from the puncture side.

Preferred side: right (justification – see above).

Technique of percutaneous puncture and catheterization of the subclavian vein according to the “catheter through catheter” principle

Puncture and catheterization of the subclavian vein can be carried out not only according to the Seldinger principle (“catheter over a guide”), but also according to the principle "catheter through catheter" . The latter technique became possible thanks to new technologies in medicine. Puncture of the subclavian vein is carried out using a special plastic cannula (external catheter) placed on a needle for catheterization of the central veins, which serves as a puncturing stylet. In this technique, the atraumatic transition from needle to cannula is extremely important, and, as a result, low resistance to passing the catheter through the tissue and, in particular, through the wall of the subclavian vein. After the cannula with the stylet needle has entered the vein, the syringe is removed from the needle pavilion, the cannula (external catheter) is held, and the needle is removed. A special internal catheter with a mandrel is passed through the external catheter to the required depth. The thickness of the internal catheter corresponds to the lumen diameter of the external catheter. The external catheter pavilion is connected using a special clamp to the internal catheter pavilion. The mandrin is removed from the latter. A sealed lid is placed on the pavilion. The catheter is fixed to the skin.

Catheter care requirements

Before each injection of a medicinal substance into the catheter, it is necessary to obtain free blood flow from it with a syringe. If this fails and fluid is injected freely into the catheter, this may be due to:

with the catheter leaving the vein;

with the presence of a hanging thrombus, which, when trying to get blood from the catheter, acts like a valve (rarely observed);

with the cut of the catheter resting against the wall of the vein.

It is impossible to carry out infusion into such a catheter. You must first tighten it slightly and try again to get blood from it. If this fails, the catheter must be unconditionally removed (risk of paravenous insertion or thromboembolism). It is necessary to remove the catheter from the vein very slowly, creating negative pressure in the catheter using a syringe. With this technique it is sometimes possible to remove a hanging thrombus from a vein. In this situation, it is strictly unacceptable to remove the catheter from the vein with rapid movements, as this can cause thromboembolism.

To avoid thrombosis of the catheter after diagnostic blood sampling and after each infusion, you should immediately rinse it with any infused solution and be sure to inject an anticoagulant into it (0.2-0.4 ml). The formation of blood clots may occur when the patient coughs severely due to blood reflux into the catheter. More often this is observed against the background of slow infusion. In such cases, heparin must be added to the transfused solution. If the liquid was administered in limited quantities and there was no constant infusion of the solution, a so-called heparin lock (“heparin plug”) can be used: after the end of the infusion, 2000–3000 units (0.2–0.3 ml) of heparin in 2 ml are injected into the catheter saline solution and it is closed with a special stopper or plug. Thus, it is possible to preserve the vascular fistula for a long time. The presence of a catheter in the central vein requires careful care of the skin at the puncture site (daily treatment of the puncture site with an antiseptic and daily change of an aseptic dressing). The duration of stay of the catheter in the subclavian vein, according to various authors, ranges from 5 to 60 days and should be determined by therapeutic indications, and not by preventive measures (V.N. Rodionov, 1996).

The easiest and fastest way to gain access for administering medications is to perform catheterization. Large and central vessels such as the internal superior vena cava or the jugular vein are mainly used. If there is no access to them, then alternative options are found.

Why is it carried out?

The femoral vein is located in the groin area and is one of the large highways that carries out the outflow of blood from the lower extremities of a person.

Catheterization of the femoral vein saves lives, since it is located in an accessible place, and in 95% of cases the manipulations are successful.

Indications for this procedure are:

impossibility of administering drugs into the jugular or superior vena cava;
hemodialysis;
carrying out resuscitation actions;
vascular diagnostics (angiography);
the need for infusions;
cardiac stimulation;
low blood pressure with unstable hemodynamics.

Preparation for the procedure

For femoral vein puncture, the patient is placed on the couch in a supine position and asked to stretch his legs and slightly spread them. Place a rubber cushion or pillow under your lower back. The surface of the skin is treated with an aseptic solution, if necessary, the hair is shaved, and the injection site is limited with sterile material. Before using the needle, locate the vein with your finger and check for pulsation.

The procedure includes:

sterile gloves, bandages, napkins;
pain reliever;
25 gauge catheterization needles, syringes;
needle size 18;
catheter, flexible guidewire, dilator;
scalpel, suture material.

Items for catheterization must be sterile and within the reach of the doctor or nurse.

Technique, Seldinger catheter insertion

Seldinger is a Swedish radiologist who in 1953 developed a method for catheterizing large vessels using a guidewire and a needle. Puncture of the femoral artery using his method is still carried out today:

The space between the symphysis pubis and the anterior iliac spine is conventionally divided into three parts. The femoral artery is located at the junction of the medial and middle third of this area. The vessel should be moved laterally, since the vein runs parallel.
The puncture site is punctured on both sides, giving subcutaneous anesthesia with lidocaine or another anesthetic.
The needle is inserted at an angle of 45 degrees at the site of vein pulsation, in the area of the inguinal ligament.
When dark cherry-colored blood appears, the puncture needle is moved along the vessel 2 mm. If blood does not appear, you must repeat the procedure from the beginning.
The needle is held motionless with the left hand. A flexible conductor is inserted into its cannula and advanced through the cut into the vein. Nothing should interfere with the movement into the vessel; if there is resistance, it is necessary to slightly turn the instrument.
After successful insertion, the needle is removed, pressing the injection site to avoid hematoma.
A dilator is put on the conductor, after first excising the insertion point with a scalpel, and it is inserted into the vessel.
The dilator is removed and the catheter is inserted to a depth of 5 cm.
After successfully replacing the guidewire with a catheter, attach a syringe to it and pull the plunger towards you. If blood flows in, an infusion with an isotonic solution is connected and fixed. Free passage of the drug indicates that the procedure was completed correctly.
After the manipulation, the patient is prescribed bed rest.

Installation of a catheter under ECG control

The use of this method reduces the number of post-manipulation complications and facilitates monitoring of the condition of the procedure., the sequence of which is as follows:

The catheter is cleaned with an isotonic solution using a flexible guide. The needle is inserted through the plug and the tube is filled with NaCl solution.
Lead “V” is attached to the needle cannula or secured with a clamp. The device switches on the “thoracic abduction” mode. Another method suggests connecting the wire of the right hand to the electrode and turning on lead number 2 on the cardiograph.
When the end of the catheter is located in the right ventricle of the heart, the QRS complex on the monitor becomes higher than normal. The complex is reduced by adjusting and pulling the catheter. A tall P wave indicates the location of the device in the atrium. Further direction to a length of 1 cm leads to the alignment of the prong according to the norm and the correct location of the catheter in the vena cava.
After the manipulations are completed, the tube is sutured or secured with a bandage.

Possible complications

When performing catheterization, it is not always possible to avoid complications:

The most common unpleasant consequence is a puncture of the posterior wall of the vein and, as a consequence, the formation of a hematoma. There are times when it is necessary to make an additional incision or puncture with a needle to remove blood that has accumulated between the tissues. The patient is prescribed bed rest, tight bandaging, and a warm compress to the thigh area.
Blood clot formation in the femoral vein has a high risk of complications after the procedure. In this case, the leg is placed on an elevated surface to reduce swelling. Medicines that thin the blood and help resolve blood clots are prescribed.
Post-injection phlebitis is an inflammatory process on the vein wall. The patient's general condition worsens, a temperature of up to 39 degrees appears, the vein looks like a tourniquet, the tissue around it swells and becomes hot. The patient is given antibacterial therapy and treatment with non-steroidal drugs.
Air embolism is the entry of air into a venous vessel through a needle. The outcome of this complication can be sudden death. Symptoms of embolism include weakness, deterioration of general condition, loss of consciousness or convulsions. The patient is transferred to intensive care and connected to a breathing apparatus. With timely assistance, the person’s condition returns to normal.
Infiltration is the introduction of the drug not into a venous vessel, but under the skin. May lead to tissue necrosis and surgical intervention. Symptoms include swelling and redness of the skin. If an infiltrate occurs, it is necessary to make absorbable compresses and remove the needle, stopping the flow of the drug.

Modern medicine does not stand still and is constantly evolving to save as many lives as possible. It is not always possible to provide assistance on time, but with the introduction of new technologies, mortality and complications after complex manipulations are decreasing.