![]() ![]() If you bury the needle without blood, gradually withdraw you may still get into the vein.When you see a flash and easy withdrawal of dark blood, this indicates entrance into the vein.Using the finder needle (largest needle in the kit) and a small syringe, enter the skin, aiming towards the sternal notch, always pulling back gently on the syringe.Using a 30-45 degree angle, bevel up, enter the skin with the 18 gauge finder needle attached to the skin.Using the blue 25 ga needle anesthetize the skin with lidocaine, and then the subcutaneous tissues with the green 22 ga needle.Be sure to enter below the inguinal crease to avoid retroperitoneal puncture.The site to choose should be 1-2 cm below the inguinal crease, about 1cm medial to the femoral pulse.Cleanse an area approx 15-20 cm below inguinal ligament.Catheter removal may not be required with coagulase-negative Staph line infection without infected skin site, but most other catheter related infections require removal and antibiotics.If line is to be removed because of suspicion of a catheter-related infection, and the skin site is not infected-looking, guide wire exchange with blood cultures through the line and culture of the tip should be performed.If site becomes infected, removal and if needed, replace at a different site. Catheter site and need should be reassessed daily. No specific time interval for changing or removal.N engl j med 356 21 INDWELLING CENTRAL VENOUS CATHETER REMOVAL GUIDELINES Nonetheless, some general statements can be made and used when obtaining consent from a patient. elective) under which the line is placed. The risk of complications of central line placement varies with the experience of the operator and the conditions (emergency vs. In patients with higher risks for pneumothorax or inability to tolerate pneumothorax, the IJ or femoral sites may also be preferred.The femoral or IJ site is preferred with a coagulopathy or anticoagulation due to the ability to compress the vein in the event of serious hemorrhage. Severe coagulopathy INR > 1.5-1.6 platelets Need for frequent blood draws where peripheral access limited.Measurement of central venous pressure replica watches.Hemorrhagic disorder where large volumes blood/blood products needed.Central venous access for infusion of vasoactive drugs, TPN, high dose KCl, etc. ![]() Femoral Central Venous Catheter INDICATIONS ![]()
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