catheter maintenance is simpler and the device does not traverse the 'beard' area. in approximately 10 per cent of people and many have been thrombosed following
The careful assessment and inspection of the selected site in respect of the venous anatomy should precede any procedure. Whenever possible, a chest radiograph should be examined for apical pulmonary bullas and other mediastinal pathology. 'Auscultation' using an ultrasound probe can successfully localize the major veins of the neck and subclavian region.
If the technique is carried out with the patient in bed, it is essential that this can be tilted adequately into a head-down situation in order to provide adequate filling of the great veins. Most techniques can be performed using regional local infiltration anesthesia supplemented if necessary by intravenous sedation and anesthesia. Careful antiseptic skin preparation is essential, and the patient should be covered by surgical drapes leaving the operative site adequately exposed. These measures eliminate any accidental contamination of the central venous catheter components during insertion. Clear adhesive incise drapes are also of benefit in the more sophisticated procedures.
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