Withoon Ungkitphaiboon Assistant Professor, Department of Surgery, Maha Chakri Sirindhorn Medical Center Srinakharinwirot University Present in “ One-day in Vascular Disease #11 4 Feb 2560 Troubleshooting Technique for Hemodialysis Catheter Insertion
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Troubleshooting Technique for Hemodialysis Catheter Insertion...Troubleshooting Technique for Hemodialysis Catheter Insertion . ... Doppler Ultrasound improve success. Short and long
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Poor Arterial BFR DLC : Kinking ,Intraluminal Clot and Sucking Wall SUCKING WALL : Turn the Catheter 180 º
Position: Medial Venous ch.
A V
SVC
180º
Lateral approach : Maxid Permcath insertion
How to get best result with Catheter insertion ?
Withoon Ungkitphaiboon
Assistant Professor, Department of Surgery,
Maha Chakri Sirindhorn Medical Center
Srinakharinwirot University
Present in “ One-day in Vascular Disease #11
4 Feb 2560
Best Function, Lowest Complication
: due to
1. Tip : Good Position
: Good design : No sucking wall
2. Curve
: Anti-kinking : Material
: High or Low insertion
: Lateral or Anterior approach
3. Diameter Large or Small
4. Length of Catheter selection
Curve
Tip
Size
–Internal jugular vein.(Rt) first
–External jugular vein.
–Subclavian vein.(Supraclav.)
–Femoral vein.
–Subclavian vein (Infraclav.)
Sites of Cannulation:
very important
Preop. Assessment
Short NeckShort Neck
Thyroid Enlargement
Previous puncture
Dilatation of superficial vein
Central Vein stenosis
• Previous Central line or DLC insertion
Failure cannulation before
Preop. Imaging: CTV & MRV
Brachiocephalic vein occlusion
MRV Central Vein of chest
Permcath(TCC)insertion technique and instrument
Anatomical landmark
Position
Modified Seldinger technique
Selection of appropriate size and length
Ultrasound with vascular probe
Fluoroscopy
Set of Mahurkar temporary double lumen HD cath.
Instrument
Doppler US(Vascular)&
Fluoroscopy
Fluoroscopy
Doppler Ultrasound
improve success
Short and long axis
Short Axis
Short Axis
SCM
Long Axis : Needle
SHORT AXIS
Ultrasound view
SHORT AXIS
Ultrasound view
Short Axis
Vertical out-of-Plane technique
Annals Surgical Treatment
and Research 2015;88(2):114-117
Cutting Edge Vascular Access Masters Course |
Wednesday, February 15, 2017 40
Cutting Edge Vascular Access Masters Course |
Wednesday, February 15, 2017 41
- Traditional Out-of-plane/Short axis
- Lateral in-plane/Short axis
(Lateral short axis in-plane)
Cutting Edge Vascular Access Masters Course |
Wednesday, February 15, 2017 42
Long axis in-plane
Short axis lateral in-plane
Short axis, Out-of-Plane
Vertical(Anterior) approach
Short Axis,
Lateral in Plane technique
Internal jugular vein(Right)
Sedillot’s triangle
Sedillot triangle
Internal jugular vein insertion(Left)
High insertion
Middle insertion
Low insertion
Cross section of internal jugular vein
Approach to int.jugular vein
Ultrasound view
SCM
Lateral
Anterior
Anterior approach
Lateral approach
High Insertion
External jugular vein
Curve into Medial
External jugular vein
Femoral Vein
Common Site of Puncture
1.(Anterior) IJV.
2.(Infraclavicular)
Subclavian V.
1
2
Subclavian Route No need to position in Trendelenberg Place small towel roll between scapulas(Infraclavicular) Abduct arm to flatten deltoid bulge(Infraclavicular) Abduct arm and pull toward down to foot(Supraclavicular)
Infraclavicular subclavian V
Mid clavicular
Supraclavicular subclavian V.
CCA
Subclavian V
- Int Jugular V
Junction
Approach to supraclav. subclavian
Advantages of Supraclavicular subclavian approach
No need for Trendelenberg No need for Head turn Lower incidence of Central