Puncture locations | Central venous catheter

Puncture locations

There are basically different places on the body available for the installation of a central venous catheter and the physician can choose the most suitable one for each patient. The prerequisite for choosing a vein is that it is large enough and the distance to the heart is not too long. The most common access route is through the neck via the internal jugular vein or via the large vein under the collarbone. Other possible puncture sites for a central venous line are the outer jugular vein or a vein on the upper arm. Under certain circumstances, the large leg vein can be used alternatively.

Preparation

Before a central venous catheter is placed in a patient, a number of preliminary examinations are necessary. In addition to an ECG (electrocardiogram), these include a blood sample, for which the determination of blood coagulation values is particularly important. A further prerequisite is that the patient or his caregiver has been informed in detail and in a way that is understandable for them.

Only if the patient gives his or her consent can the ZVK be set up. An exception is an emergency situation that requires quick action. Since an ECG must be taken during the procedure to determine the correct position of the catheter, the system includes it as part of the preparation for the placement of a central venous catheter. In some cases the patient is also given a light sleeping pill in advance.

Procedure

When a central venous catheter is placed, this is done either in the operating room, for example in the run-up to a major operation under general anesthesia, or under local anesthesia. Under local anesthesia, the catheter can also be placed in the patient’s bed on the ward. First, the doctor performing the operation must determine a suitable site for access.

The deep jugular vein in the neck is most often chosen. If necessary, the physician may use an ultrasound machine to help determine the appropriate site for the puncture, for example, if the anatomical conditions are difficult. This site is first thoroughly disinfected and anesthetized (unless the patient is already under anesthesia).

Under sterile (germ-free) conditions, the actual placement of the central venous catheter takes place in several steps according to a special technique. The most widely used is the so-called Seldinger technique. A long needle is first inserted through the skin and into the vein.

When correctly positioned, the syringe at the end of the needle can be easily filled with blood.When the needle is safely inside the vein, the syringe is removed and a thin guide wire is advanced into the vein over the needle, and then the needle is removed. The actual catheter can now be advanced along the guide wire. As soon as the correct position has been found by observing the ECG waves on the monitor, the free end of the catheter is fixed by suturing it to the skin of the neck, usually with two stitches.

The catheter is also fixed with a special plaster. In order to prevent the tubes from being blocked by blood components, the central venous catheter is also rinsed with infusion solutions. Finally, an X-ray of the chest has to be taken to check the correct position again and to rule out any injury to the lungs or pleura.

Under the latter, the system can also be installed in the patient’s bed on the ward, for example. First, the doctor performing the procedure must determine a suitable site for access. The deep jugular vein in the neck is most frequently chosen.

If necessary, the physician can use an ultrasound machine to help determine the appropriate location for the puncture, for example, if the anatomical conditions are difficult. This site is first thoroughly disinfected and anesthetized (unless the patient is already under anesthesia). Under sterile (germ-free) conditions, the actual placement of the central venous catheter takes place in several steps according to a special technique.

The most widely used is the so-called Seldinger technique. A long needle is first inserted through the skin and into the vein. When correctly positioned, the syringe at the end of the needle can be easily filled with blood.

When the needle is safely inside the vein, the syringe is removed and a thin guide wire is advanced into the vein over the needle and then the needle is removed. The actual catheter can now be advanced along the guide wire. As soon as the correct position has been found by observing the ECG waves on the monitor, the free end of the catheter is fixed by suturing it to the skin of the neck, usually with two stitches.

The catheter is also fixed with a special plaster. In order to prevent the tubes from being blocked by blood components, the central venous catheter is also rinsed with infusion solutions. Finally, an X-ray of the chest has to be taken to check the correct position again and to rule out any injury to the lungs or pleura.

A central venous catheter usually causes no significant pain. When the catheter is placed, an anesthetic is first injected into the appropriate area of skin. The puncture can be painful for a short time and then the injection can cause a slight burning sensation.

After a short period of time the area is anaesthetized and the puncture for placing the catheter causes no pain. In many cases, the central venous catheter is also placed under general anesthesia in the operating room, for example when a major operation is performed afterwards. Advancing the catheter inside the blood vessel is also painless, as the body does not feel any pain in the blood vessels.

If the catheter is then correctly positioned, it continues to cause no pain. At best, the central venous catheter is perceived as a disturbing foreign body on the neck. If pain should nevertheless occur in the area of the catheter, this should be reported immediately to the nursing staff or a doctor. It may be a sign of a wrong position or an infection of the central venous catheter.