ULTRASOUND GUIDED CENTRAL VENOUS CANNULATION

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ULTRASOUND GUIDED CENTRAL VENOUS CANNULATION

• By Dr Sunil Chhajwani (MD. Anaesthesia)

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A video presentation
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• Indications
• Haemodynamic monitoring
• Infusion of inotropes, vasodilators, vasopressors
• pacing
• Aspiration of air embolised into right side of
  heart
• Infusion of fluids

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• Placement of ultrasound guided central venous
  catheter
• Ultrasound (with high resolution probe)to be kept
  at the head end of patient
• Probe to kept transversely caudad to needle
  placement
• Probe marker should face patient's left side
• Trace the IJV from angle of mandible to
  supraclavicular fossa using linear probe in
  transverse orientatiion
  

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• Assessment of IJV
• IJV diameter should be 7 mm.
• Avoid access point to IJV where there is overlap
  with carotid artery
• Rule out thrombus in IJV
• Avoid head tilt more than 30 degrees to avoid
  transversing carotid artery

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• Use local anaesthetics without adrenaline (to
  prevent inadvertent injection into carotid
  artery)
• CVC insertion site should be prepared with usual
  sterile technique
• Ultrasound gel should be applied to linear probe
  and sterile cover to be placed over the probe
• Make sure no air bubbles between face of probe
  and sterile sleeve.

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• IJV should be imagined and placed in centre of
  ultrasound field
• Needle should be angled at 40-60 degrees at the
  angle of neck and 1 cm back from the middle of
  ultrasound probe
• If the needle is aligned correctly the soft
  tissue depression should lie exactly over the IJV
• Advance the needle in small increments of 0.5 cm

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• If the needle is seen to grow medially or
  laterally , it is withdrawn till below skin
  tissue and then directed towards IJV.
• Correct placement of needle is indicated by
  indent on IJV wall.
• Make sure needle is seen inside the IJV lumen
• Aspirate free flow of blood from IJV
• Pass guide wire through the puncturing needle

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• Look for guide wire inside the lumen of IJV by
  USG probe
• which is seen as hyper echoic dot like shadow
  when probe is kept transversely or
• hyperechoic straight shadow when probe is kept
  longitudinally to IJV
• Dilate the tract with help of dilator
• Pass central venous catheter over guide wire
• Confirm the position of cvc by USG and free
  aspiration of blood from all the lumens.