Central Line Catheter Insertion by Dr Dave | #anesthesia #anaesthesia #medicalprocedures

Summary

This instructional video script details the process of inserting a central venous catheter (CVC) using ultrasound guidance. It covers patient preparation, aseptic technique, vessel selection, and the importance of monitoring for complications. The script also provides tips for locating the internal jugular vein, avoiding the carotid artery, and ensuring proper wire placement. It emphasizes safety, including checking for correct vessel entry with ultrasound and preventing air embolism, concluding with securing the catheter and dressing the insertion site.

Takeaways

• 🔍 The script discusses a procedure for inserting a central venous catheter (CVC), focusing on the internal jugular vein (IJ).
• 🧼 The importance of aseptic technique is highlighted, including scrubbing below the elbows and ensuring patient consent and preparation.
• 📐 The use of ultrasound to locate the IJ and differentiate it from the carotid artery is emphasized, with tips for avoiding accidental puncture.
• 💉 The process of administering local anesthetic and creating a field block to numb the area is described.
• 🩺 The script mentions the use of the 'V' sign (vowel sound) to help visualize the internal jugular when the patient has a weak pulse.
• 👀 The operator should always be able to see the needle tip during the procedure to ensure safety.
• 🩸 The script describes the technique for advancing the needle and syringe into the vein, pulling back on the plunger to aspirate blood as confirmation.
• 🧵 The insertion of a guidewire through the needle and into the vein, and the importance of not hitting resistance, is explained.
• ✂️ After confirming the wire's placement, the needle is removed, and the script advises holding the wire to prevent it from being sucked back into the vessel.
• 🔪 A small incision is made to facilitate the introduction of the catheter over the guidewire.
• 🩹 The final steps involve securing the catheter with sutures and dressings, and ensuring that blood flow is dark and not arterial to confirm proper placement.

Q & A

What is the initial step described in the script for preparing a patient for a central line insertion?

The initial step is to ensure the patient has been scrubbed below the elbows and is in a sterile setup. Consent and explanation of the procedure have already been done prior to this step.

What is the significance of using an ultrasound in this procedure?

The ultrasound is used to visualize the internal jugular vein and the carotid artery to avoid accidental puncture and to ensure the needle is inserted into the correct vessel.

Why is it important to avoid puncturing the carotid artery during central line insertion?

Puncturing the carotid artery can lead to serious complications, such as bleeding, which can be life-threatening.

What technique can be used to make the internal jugular vein more visible during the procedure?

The 'V' sign or 'Vowel Salva' technique can be used, where the patient is asked to make a vowel sound, which causes the vein to bulge and become more visible.

What is a 'field block' in the context of this procedure?

A field block refers to the local anesthetic being injected in a fan-like pattern around the area where the central line will be inserted to numb the skin and reduce discomfort.

Why is it crucial to always see the needle tip when advancing the needle during the procedure?

Seeing the needle tip helps to avoid accidental complications, such as puncturing through the back wall of the vein or causing unnecessary trauma to the patient.

What does the speaker mean by 'bounce the needle' when trying to puncture a collapsed vein?

Bouncing the needle refers to a technique where the needle is gently tapped or bounced on the surface of the vein to help open it up and make it easier to puncture.

Why is it important to monitor the patient's heart rate and rhythm during the wire insertion?

Monitoring the heart rate and rhythm is important to detect any changes that might indicate the wire has touched the heart, which could cause arrhythmias or other cardiac issues.

What is the purpose of using a scalpel to make a small incision when the wire is in place?

The small incision allows for the easy passage of the catheter over the wire without causing additional trauma to the skin or the vessel.

Why is it necessary to clamp off the ports on the catheter after insertion?

Clamping off the ports prevents blood from flowing back into the catheter, which could lead to clotting and blockage of the catheter.

What is the final step described in the script for securing the central line after insertion?

The final step involves wrapping the catheter with a dressing, suturing it in place, and using a biopatch to secure it, ensuring stability and preventing infection.