Central venous catheter, how to choose the intubation site?
Release time:
2023-09-25
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1. How to choose the intubation site of central venous catheter?
At present, the order of catheter selection recommended by multiple guidelines and the consensus of Chinese experts on vascular access for hemodialysis is right internal jugular vein, left internal jugular vein, right femoral vein, left femoral vein and subclavian vein.
2. How long can central venous catheters be indwelling?
In principle, the use of non-tunnel catheters in the neck vein should not exceed 4 weeks. If it is expected to be indwelling for more than 4 weeks, tunnel catheters should be used. In principle, the non-tunnel catheter in the femoral vein should not exceed 1 week, and long-term bedridden patients can be extended to 2-4 weeks.
What are the complications of central venous catheterization?
The complications of central venous catheterization can be divided into intraoperative complications and postoperative complications. Intraoperative complications include hemorrhage, local hematoma, pneumothorax, hemothorax, mediastinal hemorrhage, air embolism and arrhythmia. Femoral vein catheterization can also occur retroperitoneal hematoma, arteriovenous fistula and aneurysm. Once the intraoperative complications should be treated in time, otherwise it is easy to endanger life.
Intraoperative complications are often related to the operation technique. Efforts to improve the operation technique and ultrasound guidance can reduce intraoperative complications. Postoperative complications are mainly caused by long-term catheter indwelling in blood vessels, which are difficult to avoid, mainly including catheter dysfunction, central venous stenosis, embolism and catheter-related infection.
4. Why is it forbidden to insert central venous catheter in subclavian vein for hemodialysis?
Because the incidence of subclavian vein stenosis caused by subclavian vein cannulation is very high, it has been reported that the incidence rate can be as high as 30%-50%, which has a direct impact on the establishment of arteriovenous fistula in the ipsilateral limb in the future. Therefore, patients who need to make arteriovenous fistula in the future should be prohibited to do subclavian venous intubation.
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