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- This is a sterile procedure.
- Extend the neck by pacing a small towel under the shoulders.
- Turn the head away from the side of the proposed venepuncture.
- Place the patient in a 25 degree head down position.
- Stand at the patient's head on the same side as the intended venepuncture.
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- Locate the lateral border of the sternocleidomastoid muscle, two finger-breadths above the clavicle.
- Infiltrate this area with local anaesthetic using a fine needle.
- You can also use this to locate the vein (see below).
- Make a small stab at the site of injection with a number 11 blade.
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- Insert the large bore needle (attached to a syringe), pointing the needle towards the clavicle and keeping the barrel parallel to the sternomastoid muscle (A).
- Then angle the syringe and needle to point towards the suprasternal notch (A to B).
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- Elevate the syringe 15 degrees above the coronal plane (B to C).
- Advance the needle towards the suprasternal notch, maintaining negative pressure on the syringe.
- When the vein is entered, hold the needle in position and remove the syringe.
- Insert the guide wire through the needle.
- Withdraw the needle while holding the end of the guide wire.
- Feed the dilator over the guide wire until it emerges out of the end of the dilator.
- Take care to ensure that you hold the end of the guide wire as the dilator is inserted.
- Remove the dilator and thread the catheter over the guide wire, again ensuring that you have a firm grasp of the end of the wire.
- Push the catheter in about 15 cm.
- Remove the guide wire.
- Flush all the catheter's lumens (aspirate first, then fill with saline).
- Suture the catheter in place.
- Apply a dressing to the area.
- Remember to confirm the catheter position by taking a chest x-ray. The tip should be in the superior vena cava or left atrium.
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Content provider: Dr Steve Walsh. Site last updated: 10/03/2001 by the Webmaster in St Marys IT Department
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