CATHETERIZATION OF VEINS PUNCTURE (grech, katheter probe; lat. punctio a prick) — introduction of a special catheter to a gleam of a vein by its transdermal puncture with the medical and diagnostic purposes. To. by accusative it began to be applied since 1953 after S. Seldinger offered a method of transdermal puncture catheterization of arteries.
Thanks to the created tools and the developed equipment the catheter can be carried out to any vein available to a puncture.
In a wedge, practice the greatest distribution was gained by puncture catheterization of subclavial and femoral veins.
Catheterization of a subclavial vein
For the first time a puncture of a subclavial vein is executed in 1952 by R. Aubaniac. The subclavial vein has the considerable diameter (12 — 25 mm), its catheterization is complicated by phlebitis, thrombophlebitis, suppuration of a wound less often that allows is long (to 4 — 8 weeks), at indications to leave a catheter in its gleam.
Indications: need of long infusional therapy (see), including at patients in terminal states, and parenteral food (see); great difficulties at vypolneniye of venipunctures of saphenas; need of a research of the central hemodynamics and biochemical, pictures of blood in the course of an intensive care; carrying out catheterizations of heart (see), angiocardiography (see) and endocardial electric cardiac activation (see. Cardiostimulation ).
Contraindications: inflammation of skin and fabrics in a zone of the punktiruyemy vein, an acute vein thrombosis which is subject to a puncture (see. Pedzheta — Schröter a syndrome ), syndrome of a prelum of an upper vena cava, coagulopathy.
Equipment. Are necessary for catheterization of a subclavial vein: a hypodermic puncture needle of a vein not less than 100 mm long with an internal gleam of channel 1,6 — 1,8 mm and a cut of an edge of a needle at an angle 40 — 45 °; set of catheters of a silikonizirovanny ftoroplast 180 — 220 mm long; a set of the conductors representing a kapron cast string 400 — 600 mm long and thickness which is not exceeding the internal diameter of a catheter, but rather densely occlusive its gleam (it is possible to use Seldinger's set); tools for anesthesia and fixing of a catheter to skin.
Position of the patient — on spin with the hands given to a trunk. The puncture of a vein is carried more often out under local anesthesia; to children and persons with the broken mentality — under the general anesthesia. Having connected an aspirating needle to the syringe half filled with solution of novocaine in one of the specified points (most often use Obanyak's point; fig. 1) pierce skin. The needle is established at an angle 30 — 40 ° to the surface of a thorax and carried slowly out to space between a clavicle and the I edge in the direction to a verkhnezadny surface of a grudinoklyuchichny joint. During the piercing of a vein the feeling of «fall» appears and in the syringe blood appears. Carefully sipping the piston on itself, under control of intake of blood in the syringe enter a needle into a gleam of a vein on 10 — 15 mm. Having disconnected the syringe, enter a catheter on depth of 120 — 150 mm into a gleam of a needle. Having recorded a catheter needles are higher, carefully remove the last from it. It is necessary to be convinced that the catheter is in a gleam of a vein (on free intake of blood in the syringe) and at a sufficient depth (on tags on a catheter). The mark "120 — 150 mm" shall be at the level of skin. The catheter is fixed to skin a silk seam. Insert a cannula (Dyufo's needle) into the distal end of a catheter, to-ruyu connect to system for injection of solutions or close a special cap, previously having filled a catheter with solution of heparin. Catheterization of a vein can be carried out also by Seldinger's method (see. Seldingera method ).
Duration of functioning of a catheter depends on the correct care of it (contents in the conditions of a strict asepsis of a wound of the puncture channel, the prevention of thrombosing of a gleam washing of a catheter after its each shutdown for a long time).
Complications: perforation of a vein, pneumo - a hemothorax, thrombophlebitis, suppuration of a wound.
Catheterization of a femoral vein
the First about a puncture of a femoral vein were reported by J. Y. Luck in 1943.
Indications. Catheterization of a femoral vein is generally applied to the diagnostic purposes: ileokavografiya (see. Flebografiya, pelvic ), angiocardiography and catheterization of heart. Owing to big danger of development of acute thrombosis in femoral or pelvic veins long catheterization of a femoral vein is not applied.
Contraindications: an inflammation of skin and fabrics in a zone of a puncture, fibrinferments of a femoral vein, a coagulopathy.
Equipment. Catheterization of a femoral vein is carried out by means of the tools used at catheterization of arteries by Seldinger's method.
Position of the patient — on spin with a little divorced legs. Under local anesthesia pierce skin 1 — 2 cm lower than an inguinal (pupartovy) sheaf in a projection of a femoral artery (fig. 2). The needle is established at an angle 45 ° to the surface of skin and will carefully see deep into to feeling of the pulsing artery. Then the end of a needle is rejected in the medial party and slowly entered under an inguinal sheaf up. About finding of a needle in a gleam of a vein judge by emergence of dark blood in the syringe. Introduction of a catheter to a vein is carried out by Seldinger's method.
Complications: injury of a vein, okolososudisty hematomas, acute vein thrombosis.
Bibliography: Gologorsky V. A., etc. Clinical assessment of catheterization of a subclavial vein, Vestn, hir., t. 108, No. 1, page 20, 1972; Aubaniac R. L’injection intraveneuse sous-claviculaire, d’aivantages et technique, Presse m6d., t. 60, p. 1456, 1952; J of f a D. Supraclavicular subclavion venepuncture and catheteri-sation, Lancet, v. 2, p. 614, 1965; L u-k e J. C. Retrograde venography of the deep leg veins, Ganad. med. Ass. J., v. 49, p. 86, 1943; Sel dinger S. I. Catheter replacement of needle in percutaneous arteriography, Acta radiol. (Stockh.), v. 39, p. 368, 1953; Verret J. e. a. La voie jugulaire externe, Cah. Anesth., t. 24, p. 795, 1976.
V. M. Buyanov.