|Minor Surgical Procedures in Remote Areas (MSF, 1989, 172 p.)|
|Chapter 3: Catheterisation and drainage|
Introduction of a percutaneous catheter into a large vein (jugular or femoral).
Peripheral venous collapse requiring rapid vacular perfusion.
Large bore needles and catheters (16 to 24 G) and intravenous fluids are needed.
External jugular vein
· Lower and turn the patient's head to the opposite side of the chosen vein.
· Rigorous asepsis: clean with polyvidone iodine (see table page 7).
· Compress the base of the neck to dilate the vein which crosses the sternomastoid muscle.
Internal jugular vein
· Gently lower and turn the patient's head to the opposite side of the chosen vein.
Rigorous asepsis: clean with polyvidone iodine and use sterile gloves.
Place a large bore needle and catheter (e.g. 16 G for an adult) on a syringe.
Puncture the head of the triangle formed by the two heads of the sternocleidomastoid and the clavicle.
Direct the needle behind, parallel to the median fine (ATTENTION: the CAROTID !) and at an angle of 30° to the horizontal.
Gently advance the needle while aspirating on the syringe. ATTENTION: do not advance too far under the clavicle because of the risk of a pneumothorax.
When blood appears, ask the patient to hold his/her breath, and
slowly advance the catheter.
- Apply a sterile dressing.
· The technique is easier than for the internal jugular vein but the region is septic.
· Rigorous asepsis.
· Place a large bore catheter on a syringe.
· Mark the crural arc; the line in the groin joining the antero-superior iliac spine and the spine of the pubis (the spine of the pubis is marked by palpating the superior border of the bone).
· Mark the edges of the femoral artery in the crural arc and fix the vessel beneath two fingers of the left hand.
· In adults, puncture lcm on the inside of the wall of the artery and 2cm below the crural arc.
· Puncture almost vertically and a little obliquely while continuously aspirating on the syringe.
· If bone is struck, withdraw while continuing to aspirate.
· When in the vein, gently lower the syringe towards the buttocks and advance the catheter. Ensure that the catheter is in the vein by aspirating blood into the syringue and then remove the introducer.
· Apply a sterile dressing.
· In the case of an arterial puncture, apply pressure for 10 minutes.