IJ venipuncture technique

IJ venipuncture technique

1. Measure length of insertion of CVL catheter such that the tip will be at the level of the SVC
2. Identify the triangle formed by the clavicle and the 2 heads of the sternocleidomastoid muscle
3. Test and fill tubing lumens of catheter with saline
4. Anesthetize the skin at the superior aspect of this triangle
5. Locate the carotid pulse
6. Use finder needle to locate IJ (if the desision is amde to use finder needle, usually it is appropraite to go straight to lg-bore since the guidewire fits through it)
   • Direct the needle caudally at a 30-45 degree angle to the skin, parallel and lateral to the carotid artery
   • Maintain negative pressure on the syringe
7. If the IJ is not located at a depth of 3-5 cm, the needle should be withdrawn to just under the skin surface, then redirected slightly laterally
8. When venous blood is aspirated, withdraw the finder needle and insert Seldinger needle along the same path

Seldinger technique

1. Upon return of venous blood, detach syringe from needle and occlude the needle hub with thumb
2. Insert guide wire into needle and advance until 10-20 cm of wire remains uninserted
3. Hold the end of the wire with one hand while withdrawing the needle with other hand
4. Using a No. 11 scalpel, make a small incision where the wire enters the skin to facilitate catheter passage
5. Advance the catheter introducer over the wire to dilate the soft tissue and opening in the vein; take care to continue to hold the end of the wire with one hand
6. Remove the catheter introducer while keeping the wire in place
7. Advance the CVL catheter over the wire (and partly withdraw the wire if necessary) until the wire is visible at the catheter hub
8. The catheter should be advanced to the desired depth
9. Withdraw the wire

Post proceedure

1. Inspect site for hematoma
2. Aspirate catheter hub(s) with syringe to check for free flow of venous blood; it is important to minimize contact with for risk of an embolus; if time allows, fill ports with saline before procedure
3. Attach IV catheter; flush bllod out of ports if multiple lumen
4. Suture the CVL catheter in place and apply a sterile dressing
5. Ausculate lungs
6. Confirm placement with post-procedure CXR

Source: www.pocketsnips.org