A peripheral intravenous catheter is an effective vascular tool. Intravenous catheter - application

IV catheters are designed to deliver medications directly into the bloodstream without repeatedly puncturing the vein over a long period of time. It is a hollow tube, inserted into the subclavian vein in the clavicle area, into the vein in the arm, and into the veins on the head in newborns.

A catheter is necessary to protect the vein from unnecessary injury when drugs are administered into the vein. Often used in cancer patients after surgical interventions in hospitals. The use of catheters has also proven successful in those patients whose veins are thin and the administration of drugs causes certain difficulties. The catheter is placed only by a health care worker in a hospital setting.

Depending on the location of placement, the following types of catheters for droppers are distinguished:

Central venous catheters

Area of application: resuscitation, cardiac surgery, oncology. Necessary for long-term administration of drugs directly into the bloodstream. The subclavian vein catheter is a set with a needle, guidewire and catheter. In addition, you need a set of disposable materials as for a minor surgical operation. And the manipulation must be carried out by a doctor who has undergone special training. This is usually done by a resuscitator. It must be remembered that the procedure has a large number of complications and many specialists prefer to use peripheral veins to administer medications.

Catheters for central veins installed from peripheral ones. The catheter is inserted into a peripheral vein and pulled into the central vein. Then the likelihood of developing complications is significantly reduced, and the medications enter directly into the central vein. Used in intensive care and neonatology.

Catheters for peripheral veins

Designed for long-term use. In appearance, this product is made of thin plastic; inside the catheter, the needle located in it is visible. After the catheter is inserted, only the catheter remains in the vein. A needle is needed to pierce the vein and insert the catheter itself. The advantage is that the plastic catheter is flexible, does not cause discomfort, and the patient can carry out everyday activities almost without noticing the catheter. Normal use time is about 3 days with good care.

Butterfly

Butterfly needles are quite common. It is a needle with plastic wings attached to the base. They are necessary to strengthen the catheter to the skin. Plus - ease of installation and use. The downside is that the needle is constantly in the vein and if you move it carelessly, the vein is always injured. Therefore, a needle is used for a single injection of drugs over 1-2 hours.

Dimensions and design

The size of the catheter is of particular importance. Depending on this, color marking is carried out. It is the same for all manufacturers. Thin catheters (the thinnest is purple) are used to administer solutions, thicker ones (orange) are for blood components and viscous liquids.

Catheters may also have an injection port. It is necessary for administering other medications through a dropper without mixing with the main solution in the bottle. The port allows bolus administration of medications without interrupting the infusion.

The administration of drugs through a catheter for a dropper has proven itself in medical practice and produces virtually no complications. But basic conditions must be met - constant care of the catheter in accordance with all the rules, it is desirable that the patient constantly use it in the treatment of diseases. If your arm hurts after a venous catheter, be sure to inform your doctor.

A catheter is placed in a vein in cases where uninterrupted access to the patient’s bloodstream is necessary, namely:

if necessary, stabilize and maintain the water-salt balance of the blood;
for intravenous administration of drugs;
for parenteral nutrition;
for transfusion of blood or its components;
to immerse the patient in anesthesia;
to detoxify the body;
to undergo a course of chemotherapy.

In such cases, placement of an intravenous catheter can be performed immediately after approval of the treatment plan, if the patient has no contraindications to this procedure.

Placement of a catheter into a vein

Before inserting a catheter into a vein, the doctor examines the future puncture site for damage, inflammation, and infection. The skin area is then disinfected and the catheter is inserted in one of three ways:

On the needle. Venous puncture is performed with the sharp end of a needle on which a catheter is placed. The needle is used to insert a subclavian catheter and catheterize the jugular vein.
Through a large bore needle. The vein is punctured using a needle, through which a flexible and soft catheter is passed.
Catheterization using the Seldinger method. This method involves puncturing a vein with a needle, through which a special conductor is passed, and a catheter is inserted through it. In this way, a catheter is placed in the central vein.

Features of placing a catheter in the central vein

Placement of a central jugular or subclavian catheter into a vein is performed on an outpatient or inpatient basis. Before inserting a catheter into the central vein, local anesthesia or anesthesia is performed. The procedure is carried out under sterile conditions, under X-ray or ultrasound control. A catheter is inserted into a vein through a needle or guidewire; the other end of the catheter is brought out and secured to the skin. When installing the U-PORT catheterization system from YURiYA-PHARM, the entire structure is placed under the skin, and injections are made into a special subcutaneous reservoir.

Peripheral catheter and its placement in a vein

Placement of a peripheral intravenous catheter begins with the selection of an appropriate catheter and selection of a vein, treatment with hand antiseptics and the site of future puncture. Then a tourniquet is applied above the puncture site, the vein is fixed and catheterization is carried out using the “through a needle” method. Then the tourniquet is removed and the needle is carefully removed. The catheter is carefully fixed to the skin. All waste after the procedure is disposed of according to the established procedure. Immediately after installation, the peripheral catheter can be used for infusions and blood sampling for analysis.

In modern medicine, there is a constant need for a single or emergency injection of drugs into a vein (for example, an antibiotic, an anesthetic) or for taking blood samples for further diagnosis and laboratory tests. Effectiveness in this matter can only be achieved through venous catheterization.

Thus, venous catheterization is the insertion of a special instrument - a catheter into the corresponding venous lumen through saphenous vein puncture or using venesection. The goal of the manipulation is to diagnose the blood or achieve a therapeutic effect in favor of the patient.

In turn, a venous (intravenous) catheter is a special medical device (a needle with a thin hollow tube) of small size, which is designed to gain access to the bloodstream by insertion into a vein.

There are two main types of cannulation: central venous catheterization and peripheral venous catheterization.

This procedure is usually performed either in the intensive care unit or in intensive care settings with the assistance of an experienced physician.

Basic methods of procedure, securing the catheter and selecting veins

There are several popular methods for inserting a catheter into a vein, for example:

The most important thing to remember when inserting a catheter is that if it is inserted incorrectly, you should immediately remove it and try to reinsert it, but at a different puncture point.

In this case, in no case should any effort be made to push the catheter further, otherwise it will not be possible to avoid damage to the puncture site or vessel.

It is imperative that after inserting the catheter, it must be securely fixed, namely:

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Thanks to the reliable fixation of the catheter, it loses the ability to move, which eliminates the possibility of irritation of the veins and puncture site.

In medicine, there are several main central veins and methods for their catheterization. In this case, catheterization of the central veins is possible only if the peripheral veins are not suitable for this.

It is important to know that with the exception of the jugular vein, all other central vessels are located quite deep under the skin, and therefore the puncture is performed almost blindly and in certain situations.

Often, the installation of a catheter and puncture into the subclavian vein is performed either by an anesthesiologist or a surgeon, and in rare cases, by a trained therapist. It can be performed from right to left and vice versa in a supraclavicular and subclavian manner using local anesthesia.

Since this subclavian vessel has excellent blood flow, the likelihood of thrombosis during catheterization is reduced.

Indications for catheterization of the subclavian veins are as follows:

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If the procedure is performed by an experienced doctor, then there is practically no possibility of complications. But this catheterization is not suitable for everyone.

There are certain contraindications in the presence of which the procedure cannot be performed, namely:

The doctor, before deciding to perform venous catheterization into the subclavian vein, will definitely have to check the patient to ensure that he has no contraindications to the procedure.

It should be noted that catheterization of the subclavian vein is a fairly simple procedure. However, if it is carried out by an inexperienced specialist, it will be extremely difficult to avoid complications. The following complications are possible:

With proper care, the catheter can last a long time, up to three months inclusive. In this case, the patient can move, taking the dropper in his hands.

Peripheral artery catheterization

This technique involves gaining access to the bloodstream for an extended period of time, which is achieved by inserting a catheter through a peripheral artery or vein. This procedure rarely causes any complications. Catheterization is done using an intravenous peripheral system (catheter) into veins with developed capillaries that are perfectly visualized.

There are many indications for venous access using peripheral venous catheterization. The main ones are the following:

If a specialist correctly selects venous access, then the success of intravenous therapy is guaranteed. At the same time, the doctor always takes into account the patient’s wishes in terms of choosing the site of catheterization, and also takes into account the accessibility when choosing a puncture point, and the suitability of the vein for the procedure.

When performing peripheral venous therapy, contraindications are extremely rare. However, there are certain conditions that limit access to this procedure, namely:

Despite some contraindications, this procedure has a number of undeniable advantages, including quick and safe access to the vein, which allows you to effectively administer medications to the found puncture point.

As for complications, they are extremely rare in practice if all the conditions for puncture and catheterization are met by the doctor. But the following complications may still appear:

As you can see, complications are only a consequence of the doctor’s incorrect actions, and not the result of the peculiarities of the patient’s body.

The artery is located quite deep, on the outside of the carotid canal and near the vagus nerve, just below the sternocleidomastoid muscle.

The peculiarity of the jugular vein is that it is clearly visible, especially in the patient’s neck. However, due to the strong mobility of the artery, this type of puncture is much more difficult than catheterization of other types of central veins.

It is worth noting that the procedure is performed under local anesthesia only by a specialist with the appropriate knowledge and practical skills in jugular vein catheterization. The procedure is carried out in the following cases:

Despite the fact that this catheterization technique is quite complex, with a competent doctor’s approach it has one undeniable advantage: during jugular puncture and insertion of a catheter, the lungs and pleura are very rarely damaged.

Before choosing a vein for further catheterization, the doctor must make sure that the patient does not have certain contraindications to the procedure. They may be as follows:

If there are no contraindications, the doctor performs the procedure using local anesthesia. The only thing that the patient should remember is that this catheterization technique is accompanied by impaired mobility in the neck.

An incorrectly inserted catheter or poor sanitation when installing the instrument can lead to adverse consequences for the patient, for example:

The likelihood of complications, in particular during jugular catheterization, often depends on the human factor, namely, the lack of professionalism of the doctor.

The intravenous catheterization technique itself is not complicated, and therefore there are often no risks of serious complications. However, without the appropriate skills, you should not carry out this procedure yourself, since proper medical training and practice are required to correctly insert such a device.

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Intravenous catheter-great thing for those with “bad” veins, which are impossible to get into if a medical procedure of “dropping” or infusion is necessary. By placing such a catheter, medical staff make it easier for both themselves and patients to infuse fluids into the body, eliminating daily injuries to the veins.

My veins are very bad. Nurses are usually exhausted to find a vein and get into it. I'm exhausted too. And so all my life. I can’t even properly take blood from a vein for analysis. On the elbow of one arm It is not possible to find a vein at all. At the very least they find it on the second hand, BUT when after numerous “pokes” they don’t get it, then the search begins veins of the hand. This is already so familiar to me.

But still there are serious reasons to insertion of an intravenous catheter It wasn’t until pregnancy struck with swelling and pressure in the last trimester. At the day hospital, the gynecologist prescribed me magnesium droppers(. The first two times, in search of a vein, the nurses searched my arms in all places. Somehow they found it and got caught together. After the second poking and torment they decided to give me intravenous catheter, so as not to torment either me or yourself.

At first I didn’t understand that the nurse was inserting this into my hand. I don’t watch the procedure itself, otherwise I might get sick. They inserted it, fixed it with a bandage, bandaged the hand and sent it home, warning that if “something goes wrong,” swelling or bleeding begins, the catheter should be pulled out.

Yes, the foreign body can be felt in the hand for the first few hours. The hand does not seem to belong to itself; it is impossible to do anything normally with it. There are no painful sensations, there is a desire to pull out the needle :) But you get used to this and begin your usual life activities.

At home, after cooking that same day, the bandage got slightly dirty, and I decided to change it. It was then that such a “spectacle” opened up. No, everything was nice, without horrors. But my impressionable child took the “needle in his hand” painfully (I feel sorry for the mother), there were even tears. If I had known, I wouldn’t have opened it in front of her.

With this by boat I walked for two days instead of three. On the third I had to pull it out, because a slight swelling appeared, the skin of the hand turned pale, and I felt uncomfortable. As the nurse said when removing the catheter: my vein is fragile, tender, weakened, it definitely wouldn’t last a day. They didn’t put anything else in the hospital.

In the department of pathologies of pregnant women of the maternity hospital, where I ended up a month and a half later, the first thing they prescribed me again was magnesium droppers. Oh, and the nurse suffered with me: she couldn’t get into a vein for a long time. I too was tortured, stabbed. As a result, the nurse called her colleague from the intensive care unit, and she immediately hit the vein. This is what experience means! But I spent a day with that catheter - blood began to flow from the vein. Put new catheter. Thank goodness, my IVs were canceled after 3 procedures and he was also quickly removed.

All catheters were opened in front of me. I didn’t buy any of them myself: there were no recommendations, and how can I find out my size? Intravenous catheters have their own varieties. As I understand it, the type is determined catheter color. I was most often given catheter with pink model. R oz catheters - they are for long-term intravenous therapy. Set once green.

An intravenous catheter is a useful thing, sometimes necessary, but I don’t want to feel it under my skin again :)

When conducting intravenous therapy through a peripheral venous catheter (PVC), complications are excluded if the following basic conditions are met: the method should not be used occasionally (become permanent and habitual in practice), the catheter should be provided with impeccable care. Well-chosen venous access is essential to successful intravenous therapy.

STEP 1. Selecting the puncture site

When selecting a catheterization site, consideration should be given to patient preference, ease of access to the puncture site, and suitability of the vessel for catheterization.

Peripheral venous cannulas are intended for use in peripheral veins only. Priorities for choosing a vein for puncture:

Well visualized veins with well developed collaterals.
Veins on the non-dominant side of the body (right-handed - left, left-handed - right).
Use distal veins first
Use veins that are soft and elastic to the touch
Veins on the side opposite to the surgical intervention.
Veins with the largest diameter.
The presence of a straight section of vein along the length corresponding to the length of the cannula.

The most suitable veins and areas for installation of PVC are: the back of the hand, the inner surface of the forearm.

The following veins are considered unsuitable for cannulation:

Veins of the lower extremities (low blood flow speed in the veins of the lower extremities leads to an increased risk of thrombosis).
Places where limbs bend (periarticular areas).
Previously catheterized veins (damage to the inner wall of the vessel is possible).
Veins located close to arteries (possibility of arterial puncture).
Median ulnar vein (Vena mediana cubiti). Puncture of this vein according to the protocols is permissible in 2 cases - taking blood for analysis, when providing emergency care and poor expression of the remaining veins.
Veins of the palmar surface of the hands (risk of vascular damage).
Veins in a limb that has undergone surgery or chemotherapy.
Veins of the injured limb.
Poorly visualized superficial veins.
Fragile and sclerotic veins.
Areas of lymphadenopathy.
Infected areas and areas of damaged skin.
Deep veins.

Table 1

Parameters and scope of application of various types of peripheral venous catheters

Color	Dimensions	PVC capacity	Application area
Orange	14G (2.0 x 45 mm)	270 ml/min.
Grey	16G (1.7 x 45 mm)	180 ml/min.	Rapid transfusion of large volumes of fluid or blood products.
White	17G (1.4 x 45 mm)	125 ml/min.	Transfusion of large volumes of fluid and blood products.
Green	18G (1.2 x 32-45 mm)		Patients undergoing routine transfusion of blood products (erythrocyte mass).
Pink	20G (1.0 x 32 mm)		Patients on long-term intravenous therapy (from 2-3 liters per day).
Blue	22G (0.8 x 25 mm)		Patients on long-term intravenous therapy, pediatrics, oncology.
Yellow	24G (0.7 x 19 mm)
Violet	26G (0.6 x 19 mm)		Oncology, pediatrics, thin sclerotic veins.

STEP 2. Selecting the type and size of catheter

When choosing a catheter, you must focus on the following criteria:

Vein diameter;
Required speed of solution introduction;
Potential residence time of the catheter in the vein;
Properties of the injected solution;
Under no circumstances should the cannula completely occlude the vein.

The main principle for choosing a catheter is to use the smallest size that provides the required insertion rate in the largest available peripheral vein.

All PVCs are divided into ported (with an additional injection port) and non-ported (without a port). Ported PVCs have an additional injection port for administering drugs without additional puncture. With its help, needle-free bolus (intermittent) administration of drugs is possible without interrupting the intravenous infusion.

Their structure always contains such basic elements as a catheter, a guide needle, a plug and a protective cap. A venesection is performed using a needle, and a catheter is inserted at the same time. The plug is used to close the catheter opening when infusion therapy is not performed (to avoid contamination), the protective cap protects the needle and catheter and is removed immediately before manipulation. For easy insertion of a catheter (cannula) into a vein, the tip of the catheter has the shape of a cone.

In addition, catheters may be accompanied by an additional design element - “wings”. Not only do they securely secure the PVC to the skin, but they also reduce the risk of bacterial contamination by preventing direct contact between the back of the catheter plug and the skin.

STEP 3. Placement of a peripheral venous catheter

Wash your hands;
Assemble a standard venous catheterization kit, including several catheters of different diameters;
Check the integrity of the packaging and shelf life of the equipment;
Make sure that in front of you is the patient who is scheduled for venous catheterization;
Provide good lighting, help the patient find a comfortable position;
Explain to the patient the essence of the upcoming procedure, create an atmosphere of trust, provide the opportunity to ask questions, determine the patient’s preferences regarding the location of the catheter;
Have a sharps disposal container available within easy reach;
Wash your hands thoroughly and dry them;
Apply a tourniquet 10-15 cm above the intended catheterization area;
Ask the patient to clench and unclench his fingers to improve the filling of the veins with blood;
Select a vein by palpation;
Remove the tourniquet;
Select the smallest catheter, taking into account: vein size, required insertion rate, intravenous therapy schedule, infusate viscosity;
Re-clean your hands using an antiseptic and put on gloves;
Apply a tourniquet 10-15 cm above the selected area;
Treat the catheterization site with a skin antiseptic for 30-60 seconds without touching untreated areas of the skin and let it dry on its own; DO NOT RE-PALPATE THE VEIN;
Secure the vein by pressing it with your finger below the intended catheter insertion site;
Take a catheter of the selected diameter using one of the grip options (longitudinal or transverse) and remove the protective cover. If there is an additional plug on the case, do not throw away the case, but hold it between the fingers of your free hand;
Make sure that the cut of the PVK needle is in the upper position;
Insert the catheter on the needle at an angle of 15 degrees to the skin, observing the appearance of blood in the indicator chamber;
If blood appears in the indicator chamber, further advancement of the needle must be stopped;
Fix the stylet needle, and slowly move the cannula completely from the needle into the vein (the stylet needle is not completely removed from the catheter yet);
Remove the tourniquet. DO NOT INSERT THE NEEDLE INTO THE CATHETER AFTER IT IS DISPLACED FROM THE NEEDLE INTO THE VEIN
Clamp the vein along its length to reduce bleeding and finally remove the needle from the catheter;
Dispose of the needle in a safe manner;
If, after removing the needle, it turns out that the vein is lost, it is necessary to completely remove the catheter from under the surface of the skin, then, under visual control, assemble the PVC (put the catheter on the needle), and then repeat the entire procedure for installing the PVC from the beginning;
Remove the plug from the protective sheath and close the catheter by inserting a heparin plug through the port or connecting the infusion set;
Secure the catheter to the limb;
Register the vein catheterization procedure according to the requirements of the medical institution;
Dispose of waste in accordance with safety regulations and sanitary and epidemiological regulations.

Standard set for peripheral vein catheterization:

Sterile tray
Garbage tray
Syringe with heparinized solution 10 ml (1:100)
Sterile cotton balls and wipes
Adhesive bandage and/or adhesive bandage
Skin antiseptic
Peripheral IV catheters in several sizes
Adapter and/or connecting tube or obturator
Sterile gloves
Scissors
Langeta
Medium bandage
3% hydrogen peroxide solution

STEP 4. Removal of the venous catheter

Wash your hands
Stop infusion or remove protective bandage (if present)
Treat your hands with antiseptic and wear gloves
From the periphery to the center, remove the fixing bandage without using scissors
Slowly and carefully remove the catheter from the vein
Apply gentle pressure to the catheterization site with a sterile gauze pad for 2-3 minutes
Treat the catheterization site with a skin antiseptic, apply a sterile pressure bandage to the catheterization site and secure it with a bandage. Recommend not to remove the bandage or wet the catheterization site for 24 hours
Check the integrity of the catheter cannula. If there is a blood clot or the catheter is suspected of being infected, cut off the tip of the cannula with sterile scissors, place it in a sterile tube and send it to a bacteriological laboratory for examination (as prescribed by a doctor)
Document the time, date, and reason for catheter removal.
Dispose of waste in accordance with safety and sanitary regulations

Venous catheter removal kit

Sterile gloves
Sterile gauze balls
Band-Aid
Scissors
Skin antiseptic
Garbage tray
Sterile tube, scissors and tray (used if the catheter is clotted or if infection of the catheter is suspected)

STEP 5. Subsequent venipunctures

If there is a need to perform several PVK placements, change them due to the end of the recommended period of PVK stay in the vein or the occurrence of complications, there are recommendations regarding the choice of venipuncture site:

It is recommended to change the catheterization site every 48-72 hours.
Each subsequent venipuncture is performed on the opposite arm or proximal (higher along the vein) of the previous venipuncture.

STEP 6. Daily catheter care

Each catheter connection is a gateway for infection. Avoid repeatedly touching the equipment with your hands. Strictly observe asepsis, work only with sterile gloves.
Change sterile plugs frequently and never use plugs whose interior surfaces may be infected.
Immediately after administering antibiotics, concentrated glucose solutions, or blood products, rinse the catheter with a small amount of saline.
Monitor the condition of the fixing bandage and change it if necessary or every three days.
Regularly inspect the puncture site for early detection of complications. If swelling, redness, local fever, obstruction of the catheter, leakage, or pain during drug administration occur, notify the doctor and remove the catheter.
When changing an adhesive bandage, do not use scissors. There is a danger for the catheter to be cut off, causing the catheter to enter the bloodstream.
To prevent thrombophlebitis, apply a thin layer of thrombolytic ointments (for example, Traumeel, Heparin, Troxevasin) to the vein above the puncture site.
The catheter should be flushed before and after each infusion session with a heparinized solution (5 ml of isotonic sodium chloride solution + 2500 units of heparin) through the port.

Possible complications:

Despite the fact that peripheral venous catheterization is a significantly less dangerous procedure compared to central venous catheterization, it carries the potential for complications, like any procedure that violates the integrity of the skin. Most complications can be avoided thanks to the nurse's good manipulation technique, strict adherence to the rules of asepsis and antisepsis, and proper care of the catheter.

table 2

Possible complications and their prevention

Possible complications
Air embolism	It is necessary to completely remove air from all plugs, additional elements and the “dropper” before connecting to the PVVC, and also stop infusions before the bottle or bag with the drug solution is empty; Use intravenous devices of appropriate length to allow the end to be lowered below the insertion site, thereby preventing air from entering the infusion system. Reliable sealing of the entire system plays an important role. The risk of air embolism during peripheral cannulation is limited by positive peripheral venous pressure (3-5 mmH2O). Negative pressure in the peripheral veins can form when choosing a site for installing a PVC above the level of the heart.
Hematoma associated with catheter removal	Apply pressure to the venipuncture site after removing the catheter 3-4 min. or raise the limb.
Hematoma associated with PVC insertion	It is necessary to ensure adequate filling of the vein and carefully plan the venipuncture procedure, not to puncture poorly contoured vessels.
Thromboembolism	Venipuncture of the lower extremities should be avoided, and the minimum possible diameter of the PVVC should be used to ensure continuous blood washing of the tip of the catheter located in the vessel.
Phlebitis	You should use an aseptic technique for installing a PVVC, choosing the smallest possible size to achieve the volumes required for intravenous therapy; securely fix the catheter to prevent its movement in the vein; ensure adequate dissolution of drugs and their administration at an appropriate rate; Change the PVVC every 48-72 hours or sooner (depending on conditions) and alternate sides of the body for the catheter insertion site.

STEP 7. Central catheter care

Puncture catheterization of the central vessels is a medical procedure. The subclavian vein, jugular and femoral veins can be punctured, both on the left and on the right. The central venous catheter can function and remain uninfected for many weeks. This is achieved through strict adherence to the rules of catheter care, including adherence to aseptic rules during its installation, precautions when performing infusions and injections.

If the catheter is left in the PV for a long time, the following complications may occur:

Vein thrombosis;

Catheter thrombosis;

Thrombo- and air embolism;

Infectious complications (5 - 40%), such as suppuration, sepsis, etc.

That is why central venous catheterization requires careful adherence to the rules of care and monitoring of the catheter:

1. Before all manipulations, you should wash your hands with soap, dry them and treat them with 70% alcohol, and put on sterile rubber gloves.

2. The skin around the catheter is inspected daily and treated with 70% alcohol and 2% iodine solution or 1% brilliant green solution.

3. The dressing is changed daily and as it gets dirty.

4. Before starting infusion therapy, ask the patient to take a breath and hold his breath. Remove the rubber stopper, attach a syringe with 0.5 ml of saline solution to the catheter, pull the piston towards you and make sure that blood flows freely into the syringe. Connect an intravenous infusion system to the catheter, allow the patient to breathe, and adjust the frequency of drops. Pour the blood from the syringe into the tray.

5. After completion of infusion therapy, it is necessary to place a heparin lock as follows:

Ask the patient to inhale and hold his breath;

Plug the catheter with a rubber stopper and allow the patient to breathe;

Through a stopper pre-treated with alcohol, inject 5 ml of solution with an intradermal needle: 2500 units (0.5 ml) of heparin + 4.5 ml of saline;

Secure the plug to the catheter with adhesive tape.

6. Be sure to rinse the catheter with the same solution as when installing a heparin lock in the following cases:

After injecting the drug through a catheter;

When blood appears in the catheter.

7. It is prohibited to bend the catheter, place clamps on the catheter that are not intended for the design, or allow air to enter the catheter.

8. If problems associated with the catheter are detected: pain, swelling of the arm, the bandage gets wet with blood, exudate or infusion medium, fever, catheter breaks, immediately inform your doctor.

9. The catheter is removed by the attending physician or anesthesiology service staff, followed by a note in the medical history.

10. It is prohibited to leave the hospital premises with a catheter! If referred to another medical institution, the patient must be accompanied by a health worker; In the discharge summary, a note is made about the presence of a subclavian catheter in the patient.

V.L. GOLOVCHENKO, L.M. ROMANOVA