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Clinical application specifications of central venous catheter

Indications

Need for hemodynamic monitoring

• Implement dynamic monitoring of central venous pressure

Special treatment needs

• Rapid infusion of large amounts of blood products or fluid replacement

• Patients receiving 1 to 4 weeks of intravenous infusion therapy

Special drug infusion

• Irritant drugs (such as vasoactive drugs)

• High osmotic pressure or viscous fluids (total parenteral nutrition, hypertonic solutions)

• Preparations with pH values significantly deviating from the physiological range

Difficulty in establishing vascular access

• Cases of failed peripheral venous puncture

Interventional treatment support

• Establishment of vascular interventional operation channel

Contraindications

Abnormal anatomical structure

• Pacing wire has been placed in the ipsilateral internal jugular vein

• Venous thrombosis in the puncture area

Local infection risk

• Active infection or cellulitis at the puncture site

Abnormal vascular access

• Hemodialysis access has been established on the same side

Circulatory system diseases

• Superior vena cava reflux syndrome

Relative contraindications

Abnormal coagulation function

• Uncorrected coagulation disorder

Posture restriction

• Abnormal anatomical structure of lower limbs affects catheterization

Operation cooperation disorder

• Impairment of consciousness leading to inability to maintain stable position

Abnormal chest structure

• Chest deformity or fracture malformation affecting puncture path

Selection of puncture site

Puncture site	Advantages	Disadvantages
Internal jugular vein	The blood vessels are thicker, easier to locate and puncture, the distance to the vena cava is short and the straight (right) complication rate is low.	Close to the carotid artery, dressing is difficult to fix, puncture point is easy to be contaminated.
Subclavian vein	Large blood vessels, high flow rate, easy to fix dressings, less restrictions on patients, and less infection possibility.	Close to the apex of the lung, prone to pneumothorax. Close to the subclavian artery. Difficult to stop bleeding.
Femoral vein	The blood vessels are thicker, easier to locate and puncture, and have advantages in emergency treatment.	Restrict patient movement, prone to thrombosis and infection. May penetrate the femoral artery. Difficult to fix the dressing.
External jugular vein	Easy to locate, and the vein is clearly exposed.	Puncture point is easy to be contaminated. Difficult to fix the dressing. Difficult to deliver the tube.

Note: Choosing the right internal jugular vein for puncture is better than the left internal jugular vein. The right internal jugular vein is almost in a straight line with the innominate vein and superior vena cava, and there is no thoracic duct on the right side. —— (Search and follow "SINKERRANG MEDICAL")