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Subclavian Line Video
This is a triple lumen catheter kit and prior to initiating the procedure, we will flush out each port with sterile saline and then recap each port. We're now drawing up 1% lidocaine for local anesthesia of the skin, subcutaneous tissue, and the periosteum of the clavicle in subclavian vein catheterization.
The large pink introducer needle is utilized for subclavian vein catheterization as opposed to the small blue introducer needle which is preferable for the internal jugular vein.
The landmarks include the sternal notch, the curve of the clavicle and the delto-pectoral groove. We are now prepping the right anterior chest wall with Chlorhexidine swabs. It's important to use a 10.5 milliliter Chlorhexidine swab or two separate 3.5 milliliter Chlorhexidine swabs, and then the Chlorhexidine is allowed to dry for at least 60 seconds.
The area is now sterilely draped with blue towels, we're identifying the curve of the clavicle and the insertion sight is roughly 1 centimeter lateral, and .5 centimeter inferior to the curve of the clavicle where we are now creating a skin wheel with 1% lidocaine. We now switched to a longer needle for good anesthesia of the periosteum of the clavicle. This significantly improves patient comfort during a subclavian vein catheter insertion.
We're now using the long pink introducer needle connected to a syringe under constant negative aspiration to introduce the needle underneath the clavicle directed one finger breadth above the sternal notch. Now, we have returned purple venous blood. The hub of the needle is grasped, and then the syringe is removed with a twisting motion, and you see non-pulsatile purple blood. The wire is now being introduced with the curve directed inferiorly and as you can see it is being advanced without any resistance.
The wire should be advanced to approximately the 20 centimeter mark. And now the wire is grasped as the needle is removed from the skin.
The scalpel is now utilized to create a knick in the skin and underlying soft tissue. And now a dilator is introduced over the wire. And the dilator is advanced to dilate a subcutaneous tract all the way into the vein. The dilator is now removed, and the wire is kept in place.
And now the pre-flushed triple lumen catheter will be introduced over the wire. The wire is being withdrawn until it can be grasped at the distal port of the catheter which is the brown port in triple lumen catheters.
Now you can see the wire grasp beyond the brown port and the catheter is advanced over the wire to a pre-designated depth of insertion. In the right subclavian vein location, the depth is typically 13 or 14 centimeters, depending on the body habitus of the patient. If you're unsure about the depth of insertion, it is preferable to advance to the deeper depth as you can always withdraw a catheter, but you cannot advance the catheter after the sterile field has been removed. The wire is now being removed and the port is capped so as to prevent an air embolus.
And now each of the three ports will be flushed again with sterile saline. Now we're placing a second clip in the mid portion of the catheter. This is helpful when a large portion of the catheter remains outside of the skin. Local anesthesia is utilized for anesthesia prior to the suture placement.
And the dilator can be used as is shown here to help tie an air knot, so that the skin is not pinched by the suture. You can see that the catheter has been secured by suture in four different locations.
And now a sterile op site is being -- it is always important to get a post-procedure chest x-ray to confirm good catheter tip location and no pneumothorax.
subclavian line video procedures and processes | |
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| Education | Upload TimePublished on 1 Sep 2012 |
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