深静脉穿刺（Deep venous puncture）.docVIP

深静脉穿刺（Deep venous puncture） Indication of deep vein puncture Severe trauma, shock, acute circulatory failure, acute renal failure and other critically ill patients should be monitored regularly. Requiring long-term parenteral nutrition or intravenous antibiotic therapy. Intravenous infusion of hypertonic solution or strong acid or alkali drugs is required. Cardiac surgery under extracorporeal circulation. Major operations that predict hemodynamic changes during surgery. Transvenous pacemaker implantation. Contraindication of deep vein puncture Partial breakage and infection. Bleeding prone. (five) common approach to puncture and catheterization Subclavian vein Clavicle Road Subclavian approach Internal jugular vein Anterior Middle road Posterior femoral vein 1) subclavian vein The subclavian vein is the continuation of the axillary vein, which originates from the lateral margin of the first rib and is 3~4cm adult. The front is the medial border of the clavicle in the clavicle slightly between the clavicle and the first rib is 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 contralateral brachiocephalic vein confluence of superior vena cava. There are two kinds of puncture routes: clavicle approach and clavicle approach. Subclavian approach position Take the best supine Trendelenburg position (Trendelenburg s position) the foot of the bed elevation is about 15~25 degrees, in order to improve the venous pressure and venous filling. This measure also ensures that the pressure in the vein is higher than the atmospheric pressure, which makes the risk of air embolism difficult during intubation, but it is not necessary for the critically ill patients. Put a small pillow straight between two scapula, clavicle shoulders sagging, elevation, whereby the subclavian vein and apical separately. The patients face turned to the opposite