It is quite difficult to imagine the modernintensive therapy without a cervical vein catheterization procedure. To insert a catheter, the subclavian vein is most often used. This procedure can be performed both below and above the clavicle. The place of insertion of the catheter is determined by a specialist.
This method of vein catheterization has a number ofadvantages: the insertion of the catheter is rather simple and comfortable for the patient. To perform this procedure, use a central venous catheter, which is a long flexible tube.
Clinical Anatomy
The subclavian vein collects blood from the upperextremities. At the level of the lower edge of the first rib, the axillary vein continues. At this point, it overcomes the first rib, and then passes along the front edge of the staircase behind the collarbone. It is located in the prehistoric gap. This space is a frontal triangular slit, which is formed by the vein groove. Surround her staircase, sternum-thyroid, sternum-hyoid muscle and clavicular-mastoid muscle tissue. The subclavian vein is located at the very bottom of this gap.
Passes through two points, while the loweris located at a distance of 2.5 centimeters inward from the coracoid process of the scapula, and the upper one goes three centimeters below the sternal margin of the end of the clavicle. In children under five years of age and newborns, it passes in the middle of the clavicle. Projection with age shifts to the middle third of the clavicle.
The vein is located slightly obliquelythe central line of the trunk. When moving with arms or neck, the topography of the subclavian vein does not change. It is due to the fact that its walls are very closely connected with the first rib, the subclavian muscles, the clavicle-thoracic fascia and the clavic periosteum.
Indications for HFV
The subclavian vein (the photo is shown below) has a rather large diameter, as a result of which its catheterization becomes most convenient.
The procedure for catheterization of this vein is shown in the case of:
- Forthcoming complex surgical intervention with possible loss of blood.
- The need for intensive care.
- Introduction of a cardiac pacemaker.
- The need to measure central pressure in the veins.
- Parenteral nutrition.
- Necessity of sensing of cardiac cavities.
- Open heart surgery.
- Need for X-ray contrast studies.
Technique of catheterization
The CPV should only be conducted by an expertand only in a specially equipped room for such a procedure. The room must necessarily be sterile. For the procedure, a resuscitation unit, an operating room or an ordinary dressing room, is suitable. In the process of preparing the patient for CPV, it must be placed on the operating table, while the head end of the table should be lowered by 15 degrees. This should be done in order to avoid the development of air embolism.
Methods of puncture
The puncture of the subclavian vein can be performed by twoways: supraclavicular access and subclavian. In this case, the puncture can be done from either side. This vein is characterized by good blood flow, which, in turn, reduces the risk of thrombosis. There is not one access point for catheterization. The greatest preference is given to specialists by the so-called Abaniac point. It is located on the border of the inner and middle third of the clavicle. The success of the catheterization at this point reaches 99%.
Contraindications to conduction of CPV
CPV, like any other medical procedure,has several contraindications. If the procedure fails or is impossible for any reason, jugular or internal and external femoral veins are used for catheterization.
The puncture of the subclavian vein is contraindicated if:
- Violations of blood clotting and hypocoagulation.
- Syndrome of the superior vena cava.
- Syndrome Paget-Schreter.
- Local inflammatory process in the proposed place of catheterization.
- Two-sided pneumothorax.
- Emphysema of lungs or severe respiratory failure.
- Injury in the collarbone area.
It should be understood that all contraindications,listed above are quite relative. In the case of a vital need for CPV, urgent access to veins, the procedure can be performed without taking into account contraindications.
Possible complications after the procedure
Most often catheterization of the subclavian vein is notentails the occurrence of serious complications. Determine any change in the process of catheterization can be by bright red pulsating blood. Experts believe that the main reason for complications is that the catheter or the conductor was not properly located in the vein.
Such a mistake can provoke the development of such unpleasant consequences as:
- Hydrothorax and infusion into the cellulose.
- Perforation of the venous wall.
- Thrombosis of the subclavian vein.
- Formation of nodes and twisting of the catheter.
- Migration of the catheter through the veins.
- Violation of the rhythm of the heart.
In this case, position adjustment is requiredcatheter. After the amendment of the port, it is required to consult consultants who have extensive experience. If necessary, the catheter is removed altogether. In order to avoid deterioration of the patient, it is necessary to immediately respond to the manifestation of symptoms of complications, especially thrombosis.
Prevention of complications
In order to prevent the development of air embolismStrict adherence to the tightness of the system is required. After the procedure is over, all patients who have transferred it are given radiography. It allows to exclude the formation of pneumothorax. Such a complication is not excluded if the catheter was in the neck for a long time. In addition, vein thrombosis, the development of air embolism, multiple infectious complications, for example, sepsis and suppuration, thrombosis of the catheter may occur.
To prevent this from happening, all manipulations should be carried out only by a highly qualified specialist.
We examined the anatomy of the subclavian vein, as well as the procedure for its puncture.
