Methods and contents of subclavian vein puncture

Subclavian vein puncture is a common emergency measure in clinical practice. It is mainly used to treat some more serious diseases. Especially when the patient is critically ill, timely subclavian vein puncture for dual-channel infusion is very helpful for emergency treatment. In order to give you a deeper understanding of subclavian vein puncture, this article will analyze the operation methods of subclavian vein puncture.

1. The patient lies supine with the head tilted to one side (the head should be tilted to the left when puncturing the right subclavian vein and to the right when puncturing the left subclavian vein).

2. Both sides of the subclavian vein can be used for puncture, but the right side is usually used because the chest duct passes through the left side, the top of the pleura is at a higher position and it is easy to be injured accidentally. The right subclavian vein is straighter and easier to insert the catheter. The puncture point is 1 to 2 cm inside the midpoint of the clavicle (or between the midpoint and the inner third of the clavicle) and at the lower edge of the clavicle (or 0.5 to 1 cm below the lower edge).

3. Perform routine disinfection on the local skin, wear gloves, and use a drape. Local anesthesia was performed with 1% procaine.

4. The assistant draws 15 ml of 0.4% sodium citrate saline and adds it into the round hole of the water gun syringe (there is a silicone rubber tube inside the water gun). Draw up 6 ml of sodium citrate saline with a 10 ml syringe, connect the puncture needle to puncture the subclavian vein. After the needle tip penetrates under the skin, it points in the direction of the head, at about 45 degrees to the longitudinal axis of the sternum, close to the chest wall and at about 15 degrees to the plane of the chest wall, so that it can just pass through the gap between the clavicle and the first rib. Insert the needle slowly, and after the blood returns, connect the needle to the water gun, use a blunt hook to hook out the end of the silicon tube from the round hole of the water gun, and press it with the left thumb. Push the water gun, and the silicon tube will quickly inject into the blood vessel along with the sodium citrate saline. Generally, the needle can enter the subclavian vein after inserting 2 to 4 cm. For needle insertion on the right side, the silicone tube should be inserted 12 to 15 cm, and for the left side, 16 to 19 cm to reach the superior vena cava.

5. Withdraw the tube and move the clavicle puncture needle slightly backward. Press the front end of the puncture needle with the index finger of your left hand, relax your finger at the round hole, move the water gun back, and the silicon tube will come out of the water gun.

6. Silicon tube connector skin needle, the end metal connector is connected to the infusion tube.

7. Fix the silicon tube at the insertion point and 3 to 4 cm away from this point by making a bottle-mouth knot with cotton thread to fix the silicon tube. The knot should not be too tight or too loose. Fix the cotton thread with 2.5 cm tape on each side. Cover the needle insertion point with a sterilized gauze with a small opening and then cover it with a piece of sterilized gauze. The subclavian vein puncture and catheterization operation is completed.

The above is an introduction to the methods and contents of subclavian vein puncture. In fact, there are many things to pay attention to during the actual operation of subclavian vein puncture. Therefore, after completing the subclavian vein puncture, the patient must do a good job of daily care, especially pay attention to not let the wound get infected. For the patient's family, they must help the patient do daily disinfection of the wound.