Brief introduction of subclavian vein puncture and intubation

Directory 1 pinyin 2 surgical name 3 overview 4 indications 5 contraindications for subclavian vein puncture and intubation 6 supplies and preparation 7 methods and contents 8 precautions 9 departments 10 related sources 1 pinyin su \ u g \ u xi à j ng m à i chu ā n c \ u ch ā gu \ u n sh \ u.

Name of operation: subclavian vein puncture and intubation

It is summarized that subclavian vein puncture intubation has important practical value for patients who need long-term and repeated intravenous infusion, especially for patients with malignant tumor undergoing chemotherapy, patients who need repeated infusion of chemotherapy drugs and drugs with blood vessels, patients with fragile blood vessels and difficult puncture, patients with advanced tumor cachexia and critically ill patients. It is an important link in clinical treatment and rescue of patients.

Indications: subclavian vein puncture intubation is suitable for total parenteral nutrition therapy, central venous pressure measurement, and those who need long-term intravenous infusion and peripheral blood vessels collapse, harden, slender and fragile, and are not easy to puncture.

1. Patients with malignant tumor need repeated infusion of chemotherapy drugs and drugs for blood vessels, which are fragile and difficult to puncture.

2. Patients with cachexia, shock or blood vessel collapse of limbs are not easy to undergo venipuncture or slide out repeatedly.

3. Those who need long-term intravenous hypernutrition treatment and infusion of hypertonic solution and intravenous nutrient solution.

4. When rescuing critically ill patients, two infusion paths are needed, and subclavian vein puncture and intubation are carried out in time.

Ensure that the infusion channel is successfully rescued.

5. subclavian vein puncture and intubation should be done before operation, and blood transfusion should be performed during and after operation.

Reduce the pain caused by repeated venipuncture to patients.

6. Those who need a lot of blood transfusion or infusion in the short term or those who need continuous infusion for a long time.

7. Patients with obesity and edema have difficulty in venipuncture.

8. Measure the central venous pressure and send it to the electrodes of the intracardiac pacemaker.

9. Pulmonary artery intubation, angiocardiography, etc.

Contraindications 1. Hemorrhagic diseases such as leukemia.

2. Patients with emphysema, thoracic deformity and extreme failure

3. Locally infected skin.

4. Patients with severe skin burns.

6 Materials and preparation equipment preparation:

1. Subclavian vein puncture disinfection includes subclavian vein puncture needle 1 branch, 2 metal scalp needle joints, blunt hook 1 branch, 5ml syringe 1 branch, 10ml syringe 1 branch, 2 No.7 needle and 20ml water gun.

2. Disinfection tray, infusion bottle, adhesive tape, disinfection cotton swab, scissors.

3.2% iodine, 1% procaine and 0.4% sodium citrate.

4. A pair of 20 ml sterile syringes and two 9 # needles (for sucking sodium citrate saline).

5. Spare necessary rescue drugs and infusion equipment.

7 methods and contents 1. The patient was supine with his head tilted to one side (right subclavian vein head tilted to the left and left subclavian vein head tilted to the right).

2. The subclavian veins on both sides of the puncture point can be used. Generally choose the right side. Because there is a thoracic duct passing through the left side, the top of the pleura is high and it is easy to be injured by accident. The right subclavian vein is straight, which is convenient for catheter insertion. The puncture point is the lower edge of the clavicle (or 0.5 ~ 1 cm below the lower edge) inside the clavicle midpoint (or between the clavicle midpoint and the inner third).

3. Routine disinfection of local skin, wearing gloves and laying a hole towel. 1% procaine local anesthesia.

4. The assistant extracts 15ml 0.4% sodium citrate physiological saline, and adds it into the round hole of the water gun syringe (the water gun has a silicone rubber tube on the inner disk). Inhale 6 ml of sodium citrate saline into a 10 ml syringe, and connect a puncture needle to puncture the subclavian vein. After the needle tip pierces the skin, it points in the direction of the head, making an angle of about 45 with the longitudinal axis of the sternum and an angle of about15 with the plane of the chest wall. As long as it can just pass through the gap between the clavicle and the first rib, slowly insert the needle, change the needle into a water gun after returning blood, and hook it out of the round hole of the water gun with a blunt hook. Push the water injection gun, the silicone tube is quickly injected into the blood vessel, and sodium citrate saline is injected. Generally, the needle can enter the subclavian vein after piercing 2 ~ 4 cm. The right needle feeder injected silicone tube 12 ~ 15 cm, and the left needle feeder reached the superior vena cava 16 ~ 19 cm.

5. Pull out the catheter and move the clavicle puncture needle back slightly. Press the front end of the puncture needle with the index finger of the left hand, loosen the finger at the round hole, and the water gun retreats, so that the silicone tube comes out of the water gun.

6. The silicone tube is connected with the scalp needle, and the end metal joint is connected with the infusion tube.

7. Fix the silicone tube at the needle entry point, 3 ~ 4 cm away from this point, and fix the silicone tube with cotton thread as the bottleneck knot. This knot should not be too tight or too loose. Both sides of the cotton thread should be fixed with 2.5 cm tape. The needle entry point should be wrapped with sterile gauze, with a small opening and a sterile gauze wrapped outside. The subclavian vein puncture and intubation operation is completed.

8 Precautions 1, subclavian venipuncture can cause complications such as pneumothorax, hematoma, hemothorax, gas embolism, infection, etc. Therefore, it can't be used as an ordinary venipuncture, and the indications should be mastered.

2, fidgeting can not be restrained, can not bring high shoulders and low shortness of breath patients, patients with emphysema with pleural apex uplift are not suitable for this operation.

3. Strict aseptic technique to prevent infection.

4. Because the deep venous catheter is placed in the superior vena cava, it is often in a negative pressure state. Pay attention to the infusion bottle must not be empty when infusion; When replacing the catheter, air should be prevented from being inhaled and air embolism should occur.

5, in order to prevent blood coagulation in the catheter, after the infusion, flush the catheter with heparin saline or 0.4% sodium citrate solution and seal it.

6. Generally, the dressing outside the catheter should be changed every day 1 time, and the local skin can be disinfected with alcohol cotton balls.

9 internal medicine

10 related sources