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CVP measurement- III

CVP measurement- III. Femoral vein cannulation. ANATOMY Femoral vein is a direct continuation of the popliteal vein. ↓ Ascends through the thigh, lying at first on the lateral side of femoral artery, then posterior & then medial to it. ↓

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CVP measurement- III

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  1. CVP measurement- III

  2. Femoral vein cannulation • ANATOMY • Femoral vein is a direct continuation of the popliteal vein. ↓ • Ascends through the thigh, lying at first on the lateral side of femoral artery, then posterior & then medial to it. ↓ • Leaves the thigh, passes behind the inguinal ligament to become the External iliac vein. ↓ • Join its counterpart from the other leg → forms the IVC (anterior & to the rt of L5 vertebrae).

  3. ANATOMY OF FEMORAL VEIN IN FEMORAL TRIANGLE TECHNIQUE OF FEMORAL VEIN CANNULATION

  4. complications • Deep vein thrombosis & thrombophlebitis. • Pulmonary embolism. • Sepsis. • Femoral artery puncture .

  5. Advantages disadvantages • Relatively simple. • High success rate - 90-95%. • Remote from the airway & pleura. • Directly compressible. • Extremely high late complication rate. • Unsuitable for long term cannulation.

  6. Peripherally inserted central catheters • Alternative to centrally inserted catheters. • Venous access obtained through an antecubital vein- basillic or cephalic vein. • ANATOMY • Basilic vein- ulnar aspect of dorsal venous network of hand. ↓ • Joins brachial vein to form axillary vein. ↓ • Continues as Subclavian vein.

  7. BASILIC VEIN CANNULATION

  8. approach • Patient’s arm at his/her side. • Antecubital fossa- prepared & draped. ↓ • Tourniquet placed proximally. • Venepuncture- proximal to antecubital crease. ↓ • Free back flow of venous blood • Tourniquet released & guidewire threaded (15-20 cms). ↓

  9. ↓ • Needle withdrawn & guidewire left in place. • Thread sheath-introducer assembly over guidewire. ↓ • Remove the guidewire. • Secure the catheter. • Rt basilic vein -52 cms. • Lt basilic vein – 56 cms.

  10. complications • Thrombophlebitis. • Limb edema. • Hematoma at the puncture site. • Infection.

  11. Advantages disadvantages • Simplicity. • Low complication rate • Safe placement by non-physicians. • Not suitable for long term placement. • Thrombophlebitis. • Passageinto SVC difficult.

  12. complications

  13. Complications contd….

  14. Cvp waveform • CVP waveform consists of- • Five phasic events • Three peaks ( a, c, v ) • Two decents ( x, y )

  15. NORMAL CVP WAVEFORM

  16. Abnormal cvp waveforms

  17. Atrial fibrillation- Absence of a wave, prominent c wave, preserved v wave & y decent. • Isorhythmic A-V dissociation- Early systolic cannon wave. • Ventricular pacing- Systolic cannon waves ( left panel).

  18. Tricuspid regurgitation- • Tall systolic c-v wave. • Loss of x decent. • Tricuspid stenosis- • Tall a wave. • Attenuation of y decent.

  19. Clinical interpretation of cvp

  20. Clinical interpretation of cvp

  21. Unreliable cvp readings

  22. Unreliable cvp readings

  23. summary • CVP is the pressure measured at the junction of right atrium & SVC. • Most sophisticated method of CVP measurement is caliberated transducer. • Most preferred route is IJV or subclavian vein. • The possibility of pneumothorax remains upto 24 hrs, so patient should be watched for it. • Strict aseptic precautions should be taken care of. • CVP catheters are used for fluid administeration , especially in ICU’s. • Femoral route , if possible should be avoided.

  24. references • Miller’s Anesthesia. 7th edition. Cardiovascular monitoring. • Monitoring in Anaesthesia and Critical Care Medicine. 5th edition. • Mcleod’s Clinical Examination. 11th edition. • Central Venous Catheters.2nd edition. • Update in Anaesthesia. Central Venous Access and Monitoring. Dr. Graham Hocking, Issue 12 (2000) Article 13. • Procedures, Techniques, And Minimally Invasive Monitoring in Intensive Care Medicine. 4th edition.

  25. THANK YOU

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