Seldinger selective angiography. Set for catheterization of central veins using the Seldinger technique

Percutaneous catheterization femoral artery Seldinger performed using a special set of tools consisting of puncture needle, dilator, introducer, metal conductor with a soft end and catheter, size 4-5 F ( by French).

Modern angiographic machines are designed in such a way that punctures It is more convenient to use the right femoral artery. The patient is placed on his back on a special table for angiography and the right leg is brought to a state of maximum pronation.

The pre-shaved right groin area is lubricated with iodine and then wiped with alcohol and isolated with disposable sterile sheets to prepare a large sterile area for conductor And catheter.

Given the topographic anatomy of the femoral artery, it is necessary to locate the inguinal ligament and mentally divide it into three parts. The projection of the passage of the femoral artery is often located at the border of the middle and medial third of the inguinal ligament. Find her palpation, as a rule, there is no difficulty in its pulsation. It's important to remember that medially from the femoral artery is the femoral vein, and laterally- femoral nerve.

With the left hand, the femoral artery is palpated on the inner surface of the lower limb 2 cm below the inguinal ligament and fixed between the index and middle fingers.

The painfulness of the manipulation requires that the conscious patient be given infiltration anesthesia with a solution of novocaine or lidocaine.

After performing local anesthesia of the skin and subcutaneous tissue with a 1% lidocaine solution or a 2% novocaine solution, produce puncture femoral artery. puncture needle is introduced in the direction pulsations, at an angle not exceeding 45 degrees, which reduces the subsequent likelihood of excessive bending catheter.

Tilting the outer end needles to the skin, pierce the front wall of the vessel. But more often needle passes both walls at once, and then the tip needles enters the lumen of the vessel only when it moves in the opposite direction.

Igloo tilted even more towards the thigh, removed from it mandrin and insert the metal conductor, the tip of which is advanced into the lumen of the artery 10-15 cm in the central direction under Poupart's ligament. While carefully advancing the instrument, it is necessary to assess the presence of resistance. When positioned correctly needles in the vessel, there should be no resistance.

Further promotion conductor, especially in persons over 50 years of age, must be carried out only under X-ray control to the level of the twelfth thoracic vertebra (Th-12).

Fix through the skin with the index finger of the left hand conductor in the lumen of the artery, and igloo taken out. Pressing with a finger prevents extraction from the artery conductor and arterial blood seeping past it under the skin.

To the outer end conductor put on dilator, corresponding in diameter to the injected catheter. Dilator enter, moving along conductor 2-3 cm into the lumen of the femoral artery.

After removal dilator put on the conductor introducer, which is entered by conductor into the femoral artery.

At the next stage catheterization required at the outer end conductor put on catheter and by promoting it distally, enter into introducer and further into the femoral artery.

From the femoral artery catheter (from the Greek kathet?r - a surgical instrument for emptying a cavity) - a tube-shaped instrument intended for the introduction of drugs and radiopaque substances into the natural channels and cavities of the body, blood and lymphatic vessels, as well as for extracting their contents for diagnostic or therapeutic purposes . carried out along the vascular bed under radiographic control until aorta, then conductor the catheter is removed and further advanced until target vessel carried out without it.

It should be remembered that after the procedure is completed, the place punctures must be securely pressed to the bone base to avoid hematoma.

External iliac artery (arteria iliaca external, femoral artery (arteria temoralis) and their branches. Front view.

1-common iliac artery;

2-internal iliac artery;

3-external iliac artery;

4-inferior epigastric artery;

5-femoral vein;

6-external genital arteries;

7-medial circumflex femoral artery;

8-femoral artery;

9-saphenous nerve;

10-lateral circumflex femoral artery;

11-deep femoral artery;

12-superficial artery, circumflex ilium;

13-inguinal ligament;

14-deep circumflex ilium artery;

15-femoral nerve.

The success of puncture and catheterization of the subclavian vein is largely due to compliance everyone requirements for carrying out this manipulation. Of particular importance is correct positioning of the patient.

Patient position horizontal with a cushion placed under the shoulder girdle (“under the shoulder blades”), 10-15 cm high. The head end of the table is lowered by 25-30 degrees (Trendelenburg position). The upper limb on the puncture side is brought to the body, the shoulder girdle is lowered (with the assistant pulling the upper limb down), the head is turned in the opposite direction by 90 degrees. In case of a serious condition of the patient, the puncture can be performed in a semi-sitting position and without placing a cushion.

Doctor's position– standing from the puncture side.

Preferred side: right, since the thoracic or jugular lymphatic ducts can flow into the terminal section of the left subclavian vein. In addition, when performing electrical cardiac stimulation, probing and contrasting the cavities of the heart, when there is a need to advance the catheter into the superior vena cava, this is easier to do on the right, since the right brachiocephalic vein is shorter than the left and its direction approaches vertical, while the direction of the left brachiocephalic vein is closer to horizontal.

After treating the hands and the corresponding half of the anterior neck and subclavian region with an antiseptic and limiting the surgical field with a cutting diaper or napkins (see section “Basic means and organization of puncture catheterization of central veins”), anesthesia is performed (see section “Anesthesia”).

The principle of central venous catheterization is laid down Seldinger (1953). The puncture is carried out with a special needle from a set for catheterization of central veins, mounted on a syringe with a 0.25% novocaine solution. For conscious patients, show the needle for puncture of the subclavian vein highly undesirable , since this is a powerful stress factor (a needle 15 cm long or more with sufficient thickness). When a needle pierces the skin, there is significant resistance. This moment is the most painful. Therefore, it must be carried out as quickly as possible. This is achieved by limiting the depth of needle insertion. The doctor performing the manipulation limits the needle with his finger at a distance of 0.5-1 cm from its tip. This prevents the needle from inserting deeply into the tissue uncontrollably when significant force is applied when piercing the skin. The lumen of the puncture needle often becomes clogged with tissue when the skin is punctured. Therefore, immediately after the needle passes through the skin, it is necessary to restore its patency by releasing a small amount of novocaine solution. The needle is inserted 1 cm below the clavicle at the border of its medial and middle third (Aubanac's point). The needle should be directed towards the postero-superior edge of the sternoclavicular joint or, according to V.N. Rodionova (1996), to the middle of the width of the clavicular pedicle of the sternocleidomastoid muscle, that is, somewhat laterally. This direction remains beneficial even with different positions of the clavicle. As a result, the vessel is punctured in the area of the venous angle of Pirogov. Advancement of the needle should be preceded by a stream of novocaine. After puncturing the subclavian muscle with a needle (a feeling of failure), the piston should be pulled toward you, moving the needle in a given direction (a vacuum can be created in the syringe only after releasing a small amount of novocaine solution to prevent clogging of the needle lumen with tissue). After entering the vein, a trickle of dark blood appears in the syringe and the needle should not be advanced further into the vessel due to the possibility of damage to the opposite wall of the vessel with subsequent exit of the conductor there. If the patient is conscious, he should be asked to hold his breath while inhaling (prevention of air embolism) and through the lumen of the needle removed from the syringe, insert a fishing line guide to a depth of 10-12 cm, after which the needle is removed, while the guide sticks and remains in the vein . Then the catheter is advanced along the guidewire in a clockwise direction to the previously specified depth. In each specific case, the principle of choosing a catheter of the maximum possible diameter must be observed (for adults, the internal diameter is 1.4 mm). After this, the guidewire is removed, a heparin solution is injected into the catheter (see section “catheter care”) and a plug cannula is inserted. To avoid air embolism, the catheter lumen should be covered with a finger during all manipulations. If the puncture is unsuccessful, it is necessary to withdraw the needle into the subcutaneous tissue and move it forward in a different direction (changes in the direction of the needle during the puncture process lead to additional tissue damage). The catheter is fixed to the skin in one of the following ways:

A strip of bactericidal plaster with two longitudinal slits is glued onto the skin around the catheter, after which the catheter is carefully fixed with a middle strip of adhesive plaster;

To ensure reliable fixation of the catheter, some authors recommend suturing it to the skin. To do this, in the immediate vicinity of the catheter exit site, the skin is stitched with a ligature. The first double knot of the ligature is tied on the skin, the second knot is fixed to the skin suture, the third knot is tied along the ligature at the level of the cannula, and the fourth knot is tied around the cannula, which prevents the catheter from moving along the axis.

manufacturer: "Vogt Medical Vertrieb GmbH", Germany

To provide long-term central venous access for the purpose of intensive infusion and/or transfusion therapy, invasive hemodynamic monitoring, and collection of blood samples for analysis.

The product is non-toxic, pyrogen-free, and can be sterilized with ethylene oxide.

Shelf life: 3 years.

Individual polyethylene packaging.

Component material:

The catheter is thermoplastic urethane.

Vascular dilator - polypropylene.

Product quality complies with the following standards: ISO 10555-1, ISO 10555-3 and ISO 10993-7;

Set for catheterization of central veins, sterile Economy G-22 x 100 mm (Article: 1318166), composition:

Single-channel central venous catheter, disposable, sterile 2.5 Fr (22G) x 100 mm, flow rate 7.3 ml/min, 1 pc. A radiopaque polyurethane catheter with an atraumatic tip in the form of a truncated cone, which reduces the risk of damage to the vascular wall and facilitates catheter installation. Installation technique: using the Seldinger method (via conductor). The catheter surface is marked along its length to facilitate determination of insertion depth.
Flow stop clamp 1 piece,
Luer-Lock plug 1 pc.,

Set for catheterization of central veins, sterile Economy 3.0 Fr (20G) x 100 mm (Article: 1318167), composition:

Single-channel central venous catheter, disposable, sterile 3.0 Fr (20G) x 100 mm, flow rate 24.6 ml/min, 1 pc. A radiopaque polyurethane catheter with an atraumatic tip in the form of a truncated cone, which reduces the risk of damage to the vascular wall and facilitates catheter installation. Installation technique: using the Seldinger method (via conductor). The catheter surface is marked along its length to facilitate determination of insertion depth.
Conducting needle 20G x 45 mm, 1 pc.;
Three-component syringe 5 ml - 1 piece;
Injection needle 22G (0.7 x 40) - 1 piece;
Fixation of the catheter to the patient's skin 1 pc.,
Flow stop clamp 1 piece,
Luer-Lock plug 1 pc.,

Set for catheterization of central veins, sterile Economy 4.0 Fr (18G) x 160 mm (Article: 1318168), composition:

Single-channel central venous catheter, disposable, sterile 4.0 Fr (18G) x 160 mm, flow rate 25.8 ml/min, 1 pc. A radiopaque polyurethane catheter with an atraumatic tip in the form of a truncated cone, which reduces the risk of damage to the vascular wall and facilitates catheter installation. Installation technique: using the Seldinger method (via conductor). The catheter surface is marked along its length to facilitate determination of insertion depth.
Three-component syringe 5 ml - 1 piece;
Injection needle 22G (0.7 x 40) - 1 piece;
Fixation of the catheter to the patient's skin 1 pc.,
Flow stop clamp 1 piece,
Luer-Lock plug 1 pc.,

Set for catheterization of central veins, sterile Economy 5.0 Fr (16G) x 200 mm (Article: 1318169), composition:

Single-channel central venous catheter, disposable, sterile 5.0 Fr (16G) x 200 mm, flow rate 57.4 ml/min, 1 pc. A radiopaque polyurethane catheter with an atraumatic tip in the form of a truncated cone, which reduces the risk of damage to the vascular wall and facilitates catheter installation. Installation technique: using the Seldinger method (via conductor). The catheter surface is marked along its length to facilitate determination of insertion depth.
Three-component syringe 5 ml - 1 piece;
Injection needle 22G (0.7 x 40) - 1 piece;
Fixation of the catheter to the patient's skin 1 pc.,
Flow stop clamp 1 piece,
Luer-Lock plug 1 pc.,

Set for catheterization of central veins, sterile Economy 7.0 Fr (14G) x 200 mm (Article: 1318170), composition:

Central venous catheter, single-channel, disposable, sterile 7.0Fr (14G) x 200 mm, flow rate 102.8 ml/min, 1 pc. A radiopaque polyurethane catheter with an atraumatic tip in the form of a truncated cone, which reduces the risk of damage to the vascular wall and facilitates catheter installation. Installation technique: using the Seldinger method (via conductor). The catheter surface is marked along its length to facilitate determination of insertion depth.
J-guidewire with one-handed delivery system 0.035" x 600 mm, 1 pc.;
Conducting needle 18G x 70 mm, 1 pc.;
Three-component syringe 5 ml - 1 piece;
Injection needle 22G (0.7 x 40) - 1 piece;
Fixation of the catheter to the patient's skin 1 pc.,
Flow stop clamp 1 piece,
Luer-Lock plug 1 pc.,

Manufacturer: "Vogt Medical Vertrieb GmbH", Germany

Set for catheterization of central veins, sterile Economy, price; RUB 425.00

Sets for central venous catheterization using the Seldinger technique

TsVK set" height="158" src="https://medams.ru/d/40189/d/%D0%9D%D0%B0%D0%B1%D0%BE%D1%80_%D0%A6% D0%92%D0%9A.jpg" style="border-width: 0px; float: right; margin: 5px;" title="Set for catheterization of central and jugular veins according to the Seldinger technique -" width="200"> !}

Polyurethane radiopaque catheter with extensions equipped with a clamp - made of radiopaque polyurethane in the form of a main smooth tube with a soft elastic tip and a supply tube with a valve assembly at the end connected to it through an adapter. The catheter has an antimicrobial coating that includes chlorhexidine, which is released from the catheter material, creating a reliable barrier against infection.

Length of the intravascular part of the catheter: 10 cm (for children) or 20 cm (for adults).

Seldinger needle (introducer)- a needle for puncture of central veins with a cut at an angle of 45°, the inner edge of the needle is chamfered for safe removal of the conductor (dimensions: 1.0 x 50 mm or 1.6 x 100 mm.)

Straight nylon conductor- reduces the risk of injury to the endothelium and subsequent thrombus formation, allows you to perform a number of manipulations to correct the position of the catheter in the vein.

Dilator (expander)- used when it is difficult to pass the catheter.

Additional fastening for fixation to the patient's skin- elastic adjustable clamp and rigid clamp clamp are designed to secure the catheter to the skin.

Plug with injection membrane- a connector with a Luer-Lock type plug prevents contact with the patient’s blood.

Mobile clamp- intended for short-term closure of the lumen of the outer section of the catheter and prevents air embolism or bleeding when manipulating the catheter.

Name, KPRV	Polyurethane radiopaque catheter				Nylon conductor	Needle size in (G)/mm and length in mm
Name, KPRV	Length(cm)	Diameters: external x internal (mm)	Size in (G)	Size in (Fr)	Size and length in mm	Needle size in (G)/mm and length in mm
1.2 x 0.6-0.4	10	1.2 x 0.6	18	3,5	0,4 - 400	(19) 1,0 - 50
1.4 x 0.8-0.6	20	1.4 x 0.8	17	4	0,6 - 600	(19) 1,0 - 50
1.6 x 1.0-0.8	20	1.6 x 1.0	16	5	0,8 - 600	(16) 1,65 - 100
1.8 x 1.2-1.0	20	1.8 x 1.2	15	5,5	1,0 - 600	(16) 1,65 - 100
2.1 x 1.4-1.2	20	2.1 x 1.4	14	6	1,2 - 600	(16) 1,65 - 100
2.3 x 1.6-1.4	20	2.3 x 1.6	13	7	1,4 - 600	(16) 1,65 - 100

Package:
The kit has a sealed consumer container, which ensures that its operational and medical qualities are preserved during the shelf life.

Buy a set for catheterization of subclavian and jugular veins

Manufacturer:
CJSC "Medsil", Russia

Set for catheterization of subclavian and jugular veins price: 446.00 rub.

manufacturer: China (t.m. "Safecath")

Product Features:

Superior Design with kink-resistant catheter increases flexibility, minimizes complications and ensures superior placement during catheterization.

Soft tip catheter provides excellent safety and avoids vascular injury.

The unique design makes the connector smooth and resilient, effectively preventing spillage leakage and protecting the solution from infection, ensuring a seal for every lumen.

Blue introducer syringe, which ensures easy and safe insertion of a conductor through it

Equipment:

Central venous catheter, high-flow, single-lumen;
Fixing 2-component wings;
Dilator;
Conductor;
Seldinger needle;
Scalpel;
Plugs;
5ml syringe with injection needle;
Introducer syringe.

Manufacturer: "Lepu Medical Technology (Beijing) Co., Ltd.", China (aka "Safecath")

Buy

vendor code	MMCVCBJ1-14-20	MMCVCBJ1-16-20	MMCVCBJ1-18-20
Number of lumens	1	1	1
Flow speed, mm/min	105	60	41
Conductor
Diameter, inches	0,035	0,035	0,021
Diameter, mm	0,89	0,89	0,53
Length, mm	600	600	600
Dilator
Diameter, Fr	8	7	5
Diameter, mm	2,7	2,3	1,65
Length, mm	90	90	50

External diameter, Ga	18	18	20
External diameter, mm	1,25	1,25	1,05
Length, mm	70	70	38
Catheter size
External diameter, mm	2,1	1,7	1,3
External diameter, Fr	6	5	4
Clearance size, Ga	14	16	18
Catheter length, mm	200	200	200
Syringe
Volume, ml	5	5	5
Introducing syringe
Volume, ml	5	5	5
price, rub.	518,00

Set for central vein catheterization using the Seldinger technique
manufacturer: "Alba Healthcare", USA

Set for central vein catheterization using the Seldinger technique includes a syringe with a sealed metal rod mounted into the piston. This allows the guidewire to be inserted directly through the syringe attached to the needle. This type of catheterization eliminates the doctor’s contact with the patient’s blood, avoids the possibility of air embolism, blood loss and reposition of the puncture needle when disconnected from the syringe for inserting the guidewire, and reduces the likelihood of catheter contamination.

Set for catheterization of central veins containing a syringe with the ability to pass a conductor through the rod, it can be recommended for catheterization of vessels in patients who have not been examined for the presence of dangerous transmissible infections, in emergency situations and when providing emergency care.

Single-lumen central venous catheter 14 G x 20 cm, kit contents:

1 piece: anesthesia needle.

1 piece: vascular dilator 8F, 10 cm
1 piece: scalpel
1 PC. bandage
Price: 500.00 rub. (Leftovers)

Single-lumen central venous catheter 16 G x 20 cm, kit contents:
1 piece: central venous catheter, radiopaque polyurethane with clamps on connecting lines, plugs with perforated caps. Soft radiopaque tip to prevent vessel injury.
1 piece: conductor 0.81 mm ´ 60 cm (straight flexible and J-shaped tips)
1 piece: soft catheter clamp
1 piece: anesthesia needle.
1 piece: 18Ga puncture needle with effective length 70mm
1 pc.: syringe with the ability to pass a guide through a 5 ml rod
1 piece: vascular dilator 6F, 10 cm
1 piece: hard catheter clamp
1 piece: scalpel
1 PC. bandage
Price: 500.00 rub. (Leftovers)

Single-lumen central venous catheter 18 G x 20 cm, kit contents:
1 piece: central venous catheter, radiopaque polyurethane with clamps on connecting lines, plugs with perforated caps. Soft radiopaque tip to prevent vessel injury.
1 piece: conductor 0.635 mm ´ 50 cm (straight flexible and J-shaped tips)
1 piece: soft catheter clamp
1 piece: anesthesia needle.
1 piece: 18Ga puncture needle with effective length 45mm
1 pc.: syringe with the ability to pass a guide through a 5 ml rod
1 piece: vascular dilator 5.5F, 6 cm
1 piece: hard catheter clamp
1 piece: scalpel
1 PC. bandage
Price: 500.00 rub. (Leftovers)

Shelf life: at least 5 years.

Sterile.

Manufacturer: "Alba Healthcare LLC", USA

Set for catheterization of central veins, single-channel 7.0 Fr (G14) x 200 mm. (Art.: 1318110), Equipment:

Central venous catheter, single-channel, disposable, sterile 7.0Fr (14G) x 200 mm, flow rate 110.0 ml/min, 1 pc. A radiopaque polyurethane catheter with an atraumatic tip in the form of a truncated cone, which reduces the risk of damage to the vascular wall and facilitates catheter installation. Installation technique: using the Seldinger method (via conductor). The catheter surface is marked along its length to facilitate determination of insertion depth.
J-guidewire with one-handed delivery system 0.035" x 600 mm, 1 pc.;
Vascular dilator 7.5Fr x 100 mm, 1 pc.;
Conducting needle 18G x 70 mm, 1 pc.;
Y-shaped connector 1 pc.;
Disposable syringe 1 pc.;
Injection needle 1 piece;
Fixation of the catheter to the patient's skin 1 pc.,
Flow stop clamp 1 piece,
Luer-Lock plug 1 pc.,

Set for catheterization of central veins, single-channel 5.0 Fr (G16) x 200 mm. (Art.: 1318107), Equipment:

Single-channel central venous catheter, disposable, sterile 5.0 Fr (16G) x 200 mm, flow rate 62.0 ml/min, 1 pc. A radiopaque polyurethane catheter with an atraumatic tip in the form of a truncated cone, which reduces the risk of damage to the vascular wall and facilitates catheter installation. Installation technique: using the Seldinger method (via conductor). The catheter surface is marked along its length to facilitate determination of insertion depth.
J-guidewire with one-handed delivery system 0.035" x 600 mm, 1 pc.;
Vascular dilator 6.5Fr x 100 mm, 1 pc.;
Conducting needle 18G x 70 mm, 1 pc.;
Y-shaped connector 1 pc.;
Blue conductor syringe modified for inserting a conductor through the piston 1 pc.;
Disposable syringe 1 pc.;
Injection needle 1 piece;
Fixation of the catheter to the patient's skin 1 pc.,
Surgical scalpel 1 pc.,
Flow stop clamp 1 piece,
Luer-Lock plug 1 pc.,
Tray for disinfectant solution 1 pc.,
Sterile removable tray, ensuring the supply of the entire set to the operator in a sterile field, 1 pc.

Set for catheterization of central veins, single-channel 4.0 Fr (G18) x 160 mm. (Art.: 1318105), Equipment:

Single-channel central venous catheter, disposable, sterile 4.0Fr (18G) x 160 mm, flow rate 32.0 ml/min, 1 pc. A radiopaque polyurethane catheter with an atraumatic tip in the form of a truncated cone, which reduces the risk of damage to the vascular wall and facilitates catheter installation. Installation technique: using the Seldinger method (via conductor). The catheter surface is marked along its length to facilitate determination of insertion depth.
J-guidewire with one-handed delivery system 0.025" x 500 mm, 1 pc.;
Vascular dilator 5.5Fr x 70 mm, 1 pc.;
Conducting needle 19G x 45 mm, 1 pc.;
Y-shaped connector 1 pc.;
Blue conductor syringe modified for inserting a conductor through the piston 1 pc.;
Disposable syringe 1 pc.;
Injection needle 1 piece;
Fixation of the catheter to the patient's skin 1 pc.,
Surgical scalpel 1 pc.,
Flow stop clamp 1 piece,
Luer-Lock plug 1 pc.,
Tray for disinfectant solution 1 pc.,
Sterile removable tray, ensuring the supply of the entire set to the operator in a sterile field, 1 pc.

Set for catheterization of central veins, single-channel 3.0 Fr (G20) x 130 mm (Art. No.: 1318103), Contents:

Single-channel central venous catheter, disposable, sterile 3.0Fr (20G) x 130 mm, flow rate 20.1 ml/min, 1 pc. A radiopaque polyurethane catheter with an atraumatic tip in the form of a truncated cone, which reduces the risk of damage to the vascular wall and facilitates catheter installation. Installation technique: using the Seldinger method (via conductor). The catheter surface is marked along its length to facilitate determination of insertion depth.
J-guidewire with one-handed delivery system 0.021" x 500 mm, 1 pc.;
Conducting needle 20G x 45 mm, 1 pc.;
Y-shaped connector 1 pc.;
Blue conductor syringe modified for inserting a conductor through the piston 1 pc.;
Disposable syringe 1 pc.;
Injection needle 1 piece;
Fixation of the catheter to the patient's skin 1 pc.,
Surgical scalpel 1 pc.,
Flow stop clamp 1 piece,
Luer-Lock plug 1 pc.,
Tray for disinfectant solution 1 pc.,
Sterile removable tray, ensuring the supply of the entire set to the operator in a sterile field, 1 pc.

Set for catheterization of central veins, single-channel 2.5 Fr (G22) x 100 mm (Art. No.: 1318101), Contents:

Single-channel central venous catheter, disposable, sterile 2.5Fr (22G) x 100 mm, flow rate 9.3 ml/min, 1 pc. A radiopaque polyurethane catheter with an atraumatic tip in the form of a truncated cone, which reduces the risk of damage to the vascular wall and facilitates catheter installation. Installation technique: using the Seldinger method (via conductor). The catheter surface is marked along its length to facilitate determination of insertion depth.
J-guidewire with one-handed delivery system 0.018" x 500 mm, 1 pc.;
Vascular dilator 4.0Fr x 50 mm, 1 pc.;
Conducting needle 20G x 45 mm, 1 pc.;
Y-shaped connector 1 pc.;
The blue conductor syringe is modified for inserting a conductor through the piston 1 pc.;
Disposable syringe 1 pc.;
Injection needle 1 piece;
Fixation of the catheter to the patient's skin 1 pc.,
Surgical scalpel 1 pc.,
Flow stop clamp 1 piece,
Luer-Lock plug 1 pc.,
Tray for disinfectant solution 1 pc.,
Sterile removable tray, ensuring the supply of the entire set to the operator in a sterile field, 1 pc.

Patient position: horizontal, there is no need to place a cushion under the shoulder girdle (“under the shoulder blades”). The head end of the table is lowered by 25-30 degrees (Trendelenburg position). The upper limb on the puncture side is brought to the body, the shoulder girdle is lowered, with the assistant pulling the upper limb down, the head is turned in the opposite direction by 90 degrees. In case of a serious condition of the patient, the puncture can be performed in a semi-sitting position.

Doctor's position– standing from the puncture side.

Preferred side: right (justification – see above).

The needle is inserted at the point Joffe, which is located in the angle between the lateral edge of the clavicular leg of the sternocleidomastoid muscle and the upper edge of the clavicle. The needle is directed at an angle of 40-45 degrees in relation to the collarbone and 15-20 degrees in relation to the front surface of the neck. As the needle is inserted, a slight vacuum is created in the syringe. Usually it is possible to enter the vein at a distance of 1-1.5 cm from the skin. A scaffold guide is inserted through the lumen of the needle to a depth of 10-12 cm, after which the needle is removed, while the guide sticks and remains in the vein. Then the catheter is advanced along the guidewire with screwing movements to the previously specified depth. If the catheter does not pass freely into the vein, its advancement can be facilitated by turning it around its axis (carefully). After this, the guidewire is removed and a plug cannula is inserted into the catheter.

Technique of percutaneous puncture and catheterization of the subclavian vein according to the “catheter through catheter” principle

Puncture and catheterization of the subclavian vein can be carried out not only according to the Seldinger principle (“catheter over a guide”), but also according to the principle "catheter through catheter" . The latter technique became possible thanks to new technologies in medicine. Puncture of the subclavian vein is carried out using a special plastic cannula (external catheter) placed on a needle for catheterization of the central veins, which serves as a puncturing stylet. In this technique, the atraumatic transition from needle to cannula is extremely important, and, as a result, low resistance to passing the catheter through the tissue and, in particular, through the wall of the subclavian vein. After the cannula with the stylet needle has entered the vein, the syringe is removed from the needle pavilion, the cannula (external catheter) is held, and the needle is removed. A special internal catheter with a mandrel is passed through the external catheter to the required depth. The thickness of the internal catheter corresponds to the lumen diameter of the external catheter. The external catheter pavilion is connected using a special clamp to the internal catheter pavilion. The mandrin is removed from the latter. A sealed lid is placed on the pavilion. The catheter is fixed to the skin.

Catheter care requirements

Before each injection of a medicinal substance into the catheter, it is necessary to obtain free blood flow from it with a syringe. If this fails and fluid is injected freely into the catheter, this may be due to:

with the catheter leaving the vein;

with the presence of a hanging thrombus, which, when trying to get blood from the catheter, acts like a valve (rarely observed);

with the cut of the catheter resting against the wall of the vein.

It is impossible to carry out infusion into such a catheter. You must first tighten it slightly and try again to get blood from it. If this fails, the catheter must be unconditionally removed (risk of paravenous insertion or thromboembolism). It is necessary to remove the catheter from the vein very slowly, creating negative pressure in the catheter using a syringe. With this technique it is sometimes possible to remove a hanging thrombus from a vein. In this situation, it is strictly unacceptable to remove the catheter from the vein with rapid movements, as this can cause thromboembolism.

To avoid thrombosis of the catheter after diagnostic blood sampling and after each infusion, you should immediately rinse it with any infused solution and be sure to inject an anticoagulant into it (0.2-0.4 ml). The formation of blood clots may occur when the patient coughs severely due to blood reflux into the catheter. More often this is observed against the background of slow infusion. In such cases, heparin must be added to the transfused solution. If the liquid was administered in limited quantities and there was no constant infusion of the solution, a so-called heparin lock (“heparin plug”) can be used: after the end of the infusion, 2000–3000 units (0.2–0.3 ml) of heparin in 2 ml are injected into the catheter saline solution and it is closed with a special stopper or plug. Thus, it is possible to preserve the vascular fistula for a long time. The presence of a catheter in the central vein requires careful care of the skin at the puncture site (daily treatment of the puncture site with an antiseptic and daily change of an aseptic dressing). The duration of stay of the catheter in the subclavian vein, according to various authors, ranges from 5 to 60 days and should be determined by therapeutic indications, and not by preventive measures (V.N. Rodionov, 1996).

The patient's position is horizontal with a cushion placed under the shoulder girdle ("under the shoulder blades"), 10-15 cm high. The head end of the table is lowered by 25-30 degrees (Trendelenburg position).

Preferred side: right, since the thoracic or jugular lymphatic ducts can flow into the terminal section of the left subclavian vein.

Anesthesia is performed

The principle of central venous catheterization is laid down Seldinger (1953).

The puncture is carried out with a special needle from a set for catheterization of central veins, mounted on a syringe with a 0.25% novocaine solution. (a needle 15 cm long or more with sufficient thickness

The doctor performing the manipulation limits the needle with his finger at a distance of 0.5-1 cm from its tip. This prevents the needle from inserting deeply into the tissue uncontrollably when significant force is applied when piercing the skin.

The needle is inserted 1 cm below the clavicle at the border of its medial and middle third (Aubanac's point). The needle should be directed towards the postero-superior edge of the sternoclavicular joint or, according to V.N. Rodionova (1996), to the middle of the width of the clavicular pedicle of the sternocleidomastoid muscle, that is, somewhat laterally. As a result, the vessel is punctured in the area of the venous angle of Pirogov. Advancement of the needle should be preceded by a stream of novocaine.

After puncturing the subclavian muscle with a needle (a feeling of failure), the piston should be pulled toward you, moving the needle in a given direction (a vacuum can be created in the syringe only after releasing a small solution of novocaine to prevent clogging of the needle lumen with tissue). After entering the vein, a trickle of dark blood appears in the syringe and the needle should not be advanced further into the vessel due to the possibility of damage to the opposite wall of the vessel with subsequent exit of the conductor there. If the patient is conscious, he should be asked to hold his breath while inhaling (prevention of air embolism) and through the lumen of the needle removed from the syringe, insert a fishing line guide to a depth of 10-12 cm, after which the needle is removed, while the guide sticks and remains in the vein . Then the catheter is advanced along the guidewire in a clockwise direction to the previously specified depth.

After this, the guidewire is removed, a heparin solution is injected into the catheter and a plug cannula is inserted. To avoid air embolism, the catheter lumen should be covered with a finger during all manipulations. If the puncture is unsuccessful, it is necessary to withdraw the needle into the subcutaneous tissue and move it forward in a different direction (changes in the direction of the needle during the puncture process lead to additional tissue damage). The catheter is fixed to the skin

Technique of percutaneous puncture and catheterization of the subclavian vein using the Seldinger method from the supraclavicular approach

Position of the patient: horizontal, there is no need to place a cushion under the shoulder girdle (“under the shoulder blades”). The head end of the table is lowered by 25-30 degrees (Trendelenburg position). The upper limb on the puncture side is brought to the body, the shoulder girdle is lowered, with the assistant pulling the upper limb down, the head is turned in the opposite direction by 90 degrees. In case of a serious condition of the patient, the puncture can be performed in a semi-sitting position.

The position of the doctor is standing on the puncture side.

Preferred side: right

Technique of percutaneous puncture and catheterization of the subclavian vein according to the “catheter through catheter” principle

Puncture and catheterization of the subclavian vein can be carried out not only according to the Seldinger principle (“catheter over a guide”), but also according to the “ catheter through catheter". Puncture of the subclavian vein is carried out using a special plastic cannula (external catheter) placed on a needle for catheterization of the central veins, which serves as a puncturing stylet. In this technique, the atraumatic transition from needle to cannula is extremely important, and, as a result, low resistance to passing the catheter through the tissue and, in particular, through the wall of the subclavian vein. After the cannula with the stylet needle has entered the vein, the syringe is removed from the needle pavilion, the cannula (external catheter) is held, and the needle is removed. A special internal catheter with a mandrel is passed through the external catheter to the required depth. The thickness of the internal catheter corresponds to the lumen diameter of the external catheter. The external catheter pavilion is connected using a special clamp to the internal catheter pavilion. The mandrin is removed from the latter. A sealed lid is placed on the pavilion. The catheter is fixed to the skin.