cvc workshop (short)
TRANSCRIPT
![Page 1: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/1.jpg)
CVC Workshop (short)
![Page 2: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/2.jpg)
Prereading
• Introduction to CVC• Basic ultrasound• Equipment List• Seldinger technique• CVC insertion
![Page 3: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/3.jpg)
Introduction
![Page 4: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/4.jpg)
Indications• IV access (especially if difficult peripheral access)
• CVP monitoring
• Central venous oxygen saturation (ScvO2 ) monitoring/sampling
• Infusions of irritant substances (e.g. vasoactive agents, calcium, chemotherapy or TPN administration)
• Renal replacement therapy, plasmapheresis and apheresis
• Transvenous pacing
![Page 5: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/5.jpg)
Contra-indications• coagulopathy
• respiratory failure (patient positioning and ability to tolerate procedure)
• raised ICP (cannot tilt head down)
– can use femoral approach in all the situations above
• obstructed vein (e.g. thrombus, tumour etc)
• overlying skin infection, burn or other disease process
• hemorrhage from target vessel
• uncooperative patient
![Page 6: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/6.jpg)
Complications• Infectious Complications
– Catheter related bloodstream infections – approximately 1.5% in Jugular CVC
• Vascular Complications– Carotid puncture/cannulation– Haematoma from multiple attempts
• Equipment– Catheter related thrombosis
• Pulmonary– Pneumothorax– Venous air embolism
![Page 7: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/7.jpg)
Sites for CVC placement• 3 main sites are used for CVC placement
– Internal jugular, subclavian and femoral
• All have the option for either left or right sided placement
• All are associated with infectious, thrombotic, and mechanical complications.
• The rate of total complications is similar for all three sites although the exact composition of the complications may differ
![Page 8: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/8.jpg)
• Surface Anatomy– How internal structures relate
to surface anatomy
![Page 9: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/9.jpg)
Ultrasound
![Page 10: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/10.jpg)
3 Ps of VASCULAR Ultrasound
• Patient• Enter patient details• Ensure patient is positioned
adequately and comfortable as possible
• Probe• Choose the high frequency linear
probe for vascular ultrasound (6-13mhz)
• Preset• Each probe can be used for multiple
tissue ie. muscle, nerves, blood vessels
• Choose the vascular setting (location of this menu will on each machine)
![Page 11: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/11.jpg)
Depth
• Depth determines how deep from the skin that you can visualise• Ideally get the object you want
in the center of the screen as demonstrated by the 4cm image to the right• This way structures below can
been seen and avoided when inserting a needle
![Page 12: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/12.jpg)
Depth
• Too much depth as demonstrated by these images results in decrease resolution• This will result in increased
difficulty in trying to needle the object of interest
![Page 13: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/13.jpg)
Gain
• This function is very similar to a brightness control• Too much or too little gain will make visualisation of objects
difficult (too bright or too dark)• Most ultrasound have an auto gain function that will attempt to
calibrate the ideal gain
![Page 14: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/14.jpg)
Gain
Gain too high can result in blurring of the walls of the structure. This is impact visualisation of the needle going through vessel walls.
Gain too low can result in structures not being seen
![Page 15: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/15.jpg)
Different ways of imaging the needle
![Page 16: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/16.jpg)
Transverse view of the right neck
Medial Lateral
![Page 17: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/17.jpg)
Seldinger Technique
![Page 18: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/18.jpg)
Steps
• Needle inserted into blood vessel while aspirating on the syringe
![Page 19: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/19.jpg)
• Syringe is removed and guidewire is inserted through the needle
![Page 20: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/20.jpg)
• Needle is removed
![Page 21: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/21.jpg)
• Dilator is inserted over guidewire to make the tract larger and then removed.
![Page 22: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/22.jpg)
• Catheter is inserted over guidewire
• Note guidewire comes out of brown port
![Page 23: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/23.jpg)
• Catheter is inserted to appropriate length
![Page 24: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/24.jpg)
Securing the central line
• Use at least O nylon, deep 1 cm bite of skin
• Secure the clip, and then sandle tie the hub so that it is secured to the skin via the clip
![Page 25: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/25.jpg)
After Care
• Following insertion of CVC:– CXR to check for complications (eg.pneumothorax)
and adequate position of CVC – tip of CVC should be in the lower Superior Vena CAVA
– Documentation of CVC insertion – including number of needle passes and any other complications
![Page 26: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/26.jpg)
• CVC need to be changed between 10 – 14 days due to increasing risk of catheter related sepsis and thrombus formation around the catheter.
• Daily review of the CVC should be implemented to check for signs of sepsis or thrombus formation and CVC not being used should be removed to reduce these risks
![Page 27: CVC Workshop (short)](https://reader036.vdocuments.us/reader036/viewer/2022062823/5871fc381a28ab5c348b7a9f/html5/thumbnails/27.jpg)
Summary
• CVC introduction– Indication and Contraindications– Complications– Anatomy
• Basic Ultrasound• Seldinger technique• After Care