Report of successful modified central vein catheterization: A technical paper

Abstract

Problem statement: Central vein catheterization (CVC) is a usual and accepted way for monitoring hemodynamic status or prescribing medication in seriously ill patients. internal jugular catheterization, is one of the most acceptable roots for catheterization, because of its accessibility and ability to compress the vein, but in the standard method explained in Robert and Hedges, clinical procedures textbook, there is significant instruction for needle direction and patient position but in some cases, this method is not successful, especially in beginner and trainer students. So new studies have examined new methods in previous approaches (such as the use of ultrasound guides). This paper is about a modified method of catheterization, with a simple modification in needle direction and patient position, based on emergency medicine specialists experience, without any excessive instruments, this method can be used by other physicians as will be explained subsequently. Objective: This study reports the success rate and complications of a verified method of central vein catheterization (CVC) by emergency medicine specialists. Methodology: After preparation and cardiac monitoring, the patient is in a neutral position with the head rotate 20-30 degrees to the other side and feet are in line with the body. Then the needle was inserted from the middle of both ends of the sternocleidomastoid muscle, one centimeter above the clavicle bone while the direction of the needle was toward the foot on the same side and along the internal jugular vein, the angle between the skin and needle was 30-40 degrees. While applying negative pressure (suction), after passing the needle through the skin, it was gently inserted into the site up to the 2.5 centimeter distance of the needle tip. In case of unsuccessful venipuncture, the needle was pulled backward gently to the surface of the skin while maintaining suction. In the case of a blood jet inside a vein, the wire was first passed and then a catheter was inserted. After catheterization, chest X-ray was taken from all patients, and complications were checked. Results: In this trial, all CVC was successful and 9 CVC were with simple complications such as catheter location in the left ventricle (n=3), in the carotid artery (n=1), pneumothorax and hemothorax (n=1). Conclusion: Since the vein is more available in the innovative modified method than the standard method, it may be preferred to the standard conventional method.