Discuss The Indications For Setting Up A Cvp Line
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Surgery Essay
Discuss the indications for setting up a CVP line. Outline briefly the potential sites and hazards associated with such sites. Placement of a central venous catheter is indicated for monitoring central venous pressure and at the same time give the clinician secure access for the rapid administration of large volumes of fluid. A CVP line is not essential in the early stages of resuscitation, since it is a thin long catheter and that hinders high flow rates as indicated by Poiseulle’s law. However, after the initial resuscitation, CVP measurements can help the clinician decide if further measurements are required and can aid in the identification of patients who may appear to be clinically normo-volemic but remain volume depleted, such as in stages 1 and 2 shock. There are two approaches. The first is known as an infraclavicular approach, which targets the subclavian vein. The patient is supine with his head down at 15 degrees. This will distend the neck veins and prevents an air embolism. A needle attached to a saline-filled syringe is inserted 1cm below the junction of the middle and inner thirds of the clavicle. The needle is aimed medially and upwards, aiming to the sterna notch. The plunger is pulled to make sure the needle is in the vein. The syringe is detached from the needle and a guide wire is inserted through the needle. The needle is removed, and the central line is inserted over the guide wire. The tip of the catheter is placed in the SVC.
1
Surgery Essay
The other approach targets the internal jugular and a Seldinger technique is used, like the one above. There are two methods to reach this artery. The high approach includes feeling for the carotid pulse anterior to the sternocleidomastoid. The needle is pointed lateral to the pulse aiming posteroinferiorly towards the nipple of the same side. The low approach targets the internal jugular between the two heads of the sternocleidomastoid. Complications include pneumothorax and haemothorax, the latter especially in the subclavian approach. An arterial puncture is possible in both approaches; however it is easier to apply pressure to the internal carotid than the subclavian artery, which is hidden deeply. Haematoma formation and infection are common to both approaches. Finally, in the infraclavicular approach a component of the brachial plexus can be damaged, as this runs close to the subclavian artery and in the internal jugular approach, the vagus nerve can be damaged as the nerve lies between the artery and vein and on the left side, the thoracic duct may be damaged. 07/02/09
2
Discuss the indications for setting up a CVP line. Outline briefly the potential sites and hazards associated with such sites. Placement of a central venous catheter is indicated for monitoring central venous pressure and at the same time give the clinician secure access for the rapid administration of large volumes of fluid. A CVP line is not essential in the early stages of resuscitation, since it is a thin long catheter and that hinders high flow rates as indicated by Poiseulle’s law. However, after the initial resuscitation, CVP measurements can help the clinician decide if further measurements are required and can aid in the identification of patients who may appear to be clinically normo-volemic but remain volume depleted, such as in stages 1 and 2 shock. There are two approaches. The first is known as an infraclavicular approach, which targets the subclavian vein. The patient is supine with his head down at 15 degrees. This will distend the neck veins and prevents an air embolism. A needle attached to a saline-filled syringe is inserted 1cm below the junction of the middle and inner thirds of the clavicle. The needle is aimed medially and upwards, aiming to the sterna notch. The plunger is pulled to make sure the needle is in the vein. The syringe is detached from the needle and a guide wire is inserted through the needle. The needle is removed, and the central line is inserted over the guide wire. The tip of the catheter is placed in the SVC.
1
Surgery Essay
The other approach targets the internal jugular and a Seldinger technique is used, like the one above. There are two methods to reach this artery. The high approach includes feeling for the carotid pulse anterior to the sternocleidomastoid. The needle is pointed lateral to the pulse aiming posteroinferiorly towards the nipple of the same side. The low approach targets the internal jugular between the two heads of the sternocleidomastoid. Complications include pneumothorax and haemothorax, the latter especially in the subclavian approach. An arterial puncture is possible in both approaches; however it is easier to apply pressure to the internal carotid than the subclavian artery, which is hidden deeply. Haematoma formation and infection are common to both approaches. Finally, in the infraclavicular approach a component of the brachial plexus can be damaged, as this runs close to the subclavian artery and in the internal jugular approach, the vagus nerve can be damaged as the nerve lies between the artery and vein and on the left side, the thoracic duct may be damaged. 07/02/09
2
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