Subclavian vein cannulation
Subclavian vein cannulation is a medical procedure that is performed for central venous access.It allows sampling of blood as well as administration of medications.It is not the first option for venous cannulation instead it is used in patients with cervical spine injury and it is a preferred method of cannulation for long term use (dialysis, feeding).
Indications
Subclavian vein cannulation is preferred in following conditions:
* Cervical spine injury
*Measurement of central venous pressure
* Administration of medicines (vasopressors, chemotherapy)
* Hyperalimentation
* Continuous renal replacement therapy
* Hemodialysis
* Poor peripheral venous access
Contraindications
Subclavian venous cannulation should not be performed in the following conditions:
* Infection on the site of cannulation
* Subclavian vein thrombosis
* Fracture of clavicle and ribs of the same side
* Coagulation disorders
Equipment
You should have the following equipments ready to perform the subclavian vein cannulation:
* Sterile gloves
* Sterile drape
* Antiseptic solution ( alcohol or providine-iodine solution)
* Local anesthetic (2% Lidocaine)
* 14-gauge intracath needle with 3 ml non-luer-lok plastic syringe
* Intravenous tubing and stand
* Intravenous solution
* Silk Sutures
* Dressing
* Tape
Procedure
1-Place the patient in 15 degree trendelenburg position.
2-Wear sterile gloves and drape the area.
3-Identify the site.
4-Infiltrate the local anesthetic.
5-Insert the intracath needle attached to the syringe at middle and 2-3 cm caudal to clavicle, at 30 degrees towards the sternal notch.Vein is accessed under the clavicle.
6- Aspirate the syringe gently when free flow of blood appears, remove the syringe and insert the needle into the subclavian vein.
7-Advance the needle into superior vena cava about 15 cm in adults.
8-Apply needle guard.
9-Aspirate and flush the cannula with normal saline filled syringe.
10-Suture cannula to skin.
11-Remove the syringe and fix the cannula to the skin using tape.
12-Apply dressing.
13-Obtain x-ray to check the placement of cannula.
Complications
* Pneumothorax
* Perforation of lung
* Hemothorax
* Hydrothorax
* Hematoma
* Air embolism
* Subclavian vein thrombosis
* Damage to subclavian artery
Patients education
Inform the patient about the procedure and the complications that can be caused by the procedure.After the completion of subclavian vein cannulation, ask your patient to take care of the subclavian line, change the dressing three times daily.Tell him to contact the doctor in case of any complications including fever.
Intravenous cannulation
Intravenous cannulation is a very common bedside medical procedure in which
a cannula is inserted into a vein for administration of fluids, medicine and
for the collection of blood sample.Its an easy and short procedure to gain IV
access and it is normally completed in 2-5 minutes.
