中心静脉穿刺置管术（Central venous catheterization）.docVIP

中心静脉穿刺置管术（Central venous catheterization） Central venous catheterization Central venous pressure (CVP) is a measure of the left and right heart blood discharge capacity and determine the effective circulating blood volume index, now has been widely used in clinic. One indication. 1. kinds of cardiovascular surgery under extracorporeal circulation 2. estimation operation will appear in off-pump hemodynamic changes greatly 3. rescue of severe trauma, shock and acute circulatory failure in critically ill patients 4. long term high nutrition therapy or intravenous antibiotic therapy 5. of some drugs or other treatment of circulatory system 6. placed transvenous temporary or permanent cardiac pacemaker Two. Puncture approach At present the method of percutaneous puncture catheter placement to central venous site. The puncture site used the subclavian vein, internal jugular vein, in some special cases can also be basilic vein or femoral vein. 1. subclavian vein subclavian vein is a continuation of the axillary vein, lateral ribs originated from first adults, about 3~4cm. The front is the medial border of the clavicle in the clavicle and clavicle slightly is located between the first ribs slightly arched upward and inward and slightly inward and forward across the anterior scalene muscle in sternoclavicular joint with internal jugular vein converged into the innominate vein, and medial innominate vein confluence of superior vena cava. Usually choose the right subclavian vein puncture as well. Puncture approach with supraclavicular and infraclavicular road two. The supraclavicular patient supine head low, right shoulder pad, head to the right side, the supraclavicular fossa revealed. In the thoracic lateral margin of sternocleidomastoid clavicular head, supraclavicular margin of about 1.0cm into the needle, and the needle body midline or clavicle at an angle of 45 degrees, to maintain the level or slightly forward 15 degrees and coronal, tip pointing to the sternoclavicular