The peripheral intravenous catheter is an effective instrument for blood vessels. Intravenous catheter - application

IV catheters are designed to administer drugs directly into the bloodstream, without re-piercing the vein for a long time. It is a hollow tube, inserted into the subclavian vein in the clavicle, into the vein on the arm, into the veins on the head in newborns.

The catheter is necessary to save the vein from unnecessary injury when drugs are injected into the vein. It is often used in cancer patients, after surgical interventions in hospitals. Also, the use of catheters has proven itself well in those patients in whom the veins are thin and the administration of drugs causes certain difficulties. The placement of the catheter is performed only by a health worker in a hospital setting.

Depending on the place of setting, the following types of catheters for a dropper are distinguished:

Central venous catheters

Scope - 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, a set of disposable materials is needed as for a minor surgical operation. Yes, and the manipulation should 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 for the administration of drugs.

Catheters for the central veins, installed from the peripheral. The catheter is inserted into a peripheral vein and pulled into the central one. Then the likelihood of complications is significantly reduced, and the medicines enter directly into the central vein. It is used in intensive care, 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 insertion of the catheter, 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 go about his daily activities, almost without noticing the catheter. Usual use time is about 3 days with good care.

Butterfly

Butterfly-type needles are quite common. It is a needle with plastic wings attached to its base. They are necessary to strengthen the catheter to the skin. Plus - ease of setting and use. The downside is that there is always a needle 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 for 1-2 hours.

Dimensions and design

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

Also, catheters may have an injection port. It is necessary for the introduction of other drugs through a dropper without mixing with the main solution in the vial. The port provides bolus delivery of drugs without interrupting the infusion.

The introduction of drugs through a catheter for a dropper has proven itself in medical practice, practically does not give complications. But the basic conditions must be met - constant care for the catheter in accordance with all the rules, it is desirable to constantly use the patient in the treatment of diseases. If your arm hurts after a vein catheter, be sure to inform your doctor.

The placement of a catheter into a vein is performed 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;
for detoxification of the body;
for a course of chemotherapy.

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

Placement of a catheter in a vein

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

On the needle. The puncture of the vein is performed with the sharp end of the needle on which the catheter is put on. The needle is used to insert a subclavian catheter and catheterize the jugular vein.
Through a large lumen needle. The vein is punctured with a needle, inside which a flexible and soft catheter is passed.
Catheterization by 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 a central vein.

Features of placing a catheter in a central vein

The placement of a central jugular or subclavian catheter into a vein is performed on an outpatient or inpatient basis. Before placing the catheter in 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 through a needle or conductor into a vein, the other end of the catheter is brought out and fixed on the skin. When installing the U-PORT catheterization system from YURiA-PHARM, the entire structure is placed under the skin, and injections are performed in a special subcutaneous reservoir.

Peripheral catheter and its placement in a vein

The setting of a peripheral intravenous catheter begins with the selection of an appropriate catheter and the choice of a vein, antiseptic treatment of the hands and the site of the future puncture. Then a tourniquet is applied above the puncture site, the vein is fixed and catheterization is performed using the “through the needle” method. Then the tourniquet is removed, the needle is carefully removed. The catheter is carefully fixed on the skin. All waste after the procedure is disposed of in accordance with the established procedure. Immediately after insertion, the peripheral catheter can be used for infusion and blood sampling.

In modern medicine, there is a constant need for a single or emergency injection of drugs (for example, an antibiotic, an anesthetic) into a vein or for the collection of blood samples for further diagnosis and laboratory testing. To achieve efficiency in this matter is possible only through catheterization of the veins.

Thus, venous catheterization is the introduction of a special instrument - a catheter into the corresponding venous lumen by saphenous vein puncture or venesection. The task of manipulation is to diagnose 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 inserting into a vein.

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

This procedure is usually performed either in the intensive care unit or in intensive care units with the participation of an experienced doctor.

Basic methods of the procedure, fixation of the catheter and selection of 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 in case of incorrect insertion, you should immediately remove it and try to insert it again, but at a different puncture point.

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

Be sure, after inserting the catheter, it must be securely fixed, namely:

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

In medicine, there are several main central veins and methods for their catheterization. At the same time, 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 deep enough 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 the supraclavicular and subclavian way 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 the possibility of complications is practically absent. But this catheterization is not suitable for everyone.

There are certain contraindications, in the presence of which it is impossible to carry out the procedure, namely:

The doctor, before deciding to conduct venous catheterization into the subclavian vein, will definitely have to check the patient for any 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, then 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. In this case, the patient can move around, taking a dropper in his hands.

Peripheral artery catheterization

This technique involves obtaining access to the blood flow for an extended period of time, which is achieved by placing a catheter through peripheral arteries or veins. This procedure rarely causes any complications. Catheterization is done using an intravenous peripheral system (catheter) into the 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 a venous access, then the success of intravenous therapy is guaranteed. At the same time, the doctor always takes into account the wishes of the patient in terms of choosing a catheterization site, and also takes into account the availability when choosing a puncture point, and the suitability of the vein for the procedure.

When conducting 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 drugs to the found puncture point.

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

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

The artery is located deep enough, 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 perfectly 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 should be noted that the procedure is performed under local anesthesia only by a specialist with the appropriate knowledge and practical skills of jugular vein catheterization. Carry out the procedure in the following cases:

Despite the fact that this catheterization technique is quite complicated, with a competent doctor’s approach, it has one indisputable advantage: during jugular puncture and catheter insertion, 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, using local anesthesia, performs the procedure. The only thing that the patient should remember is that this catheterization technique is accompanied by impaired mobility in the neck.

Incorrectly inserted catheter or non-hygienic conditions when inserting an instrument can lead to adverse consequences for the patient, for example:

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

In itself, the technique of intravenous catheterization is not complicated, and therefore the risks of serious complications are often absent. However, without the appropriate skills, you should not carry out this procedure on your own, since for the competent introduction of such a device, appropriate medical training and practice is required.

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intravenous catheter-great item for those with "bad" veins, into which it is impossible to get if necessary, the medical procedure of "instillation", infusion. By placing such a catheter, the medical staff facilitates both themselves and patients the procedure for infusing fluid into the body, eliminating daily injury to the veins.

My veins are very bad. Nurses usually go to great lengths to find a vein and get into it. I'm exhausted too. And so all my life. I can’t even take blood from a vein for analysis normally. On the elbow of one arm no vein at all. At the very least, they find it on the second hand, BUT when, after numerous "pokes", they do not hit, the search begins hand veins. For me, this is already so familiar.

However, there are serious reasons for insertion of an intravenous catheter it wasn’t until pregnancy broke out with edema and pressure in the last trimester. In the day hospital, the gynecologist prescribed me magnesium droppers. The first two times, looking for a vein, the nurses looked for my hands in all places. Somehow they found and fell together. After the second poking-torment, they decided to put me intravenous catheter so as not to torment me or myself.

At first I did not understand that a nurse was inserting this into my hand. I don’t look at the procedure itself, otherwise I might get sick. Inserted, fixed with a plaster, bandaged the brush and sent home, warning that if "something goes wrong", swelling or bleeding occurs, the catheter should be removed.

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

At home, after cooking on the same day, the bandage was slightly dirty, and I decided to change it. It was then that such a "spectacle" opened up. No, everything was nice, without horror. But my impressionable child painfully accepted the "needle in his hand" (I feel sorry for my mother), there were even tears. If I had known, I would not have unfolded in front of her.

With this by boat I went two days instead of three. On the third I had to pull out, because there was a slight swelling, the skin of the hand turned pale, and I became uncomfortable. As the nurse said during the removal of the catheter: my wreath is fragile, tender, weakened, it would definitely not last a day. Nothing more was done in the hospital.

In the department of pathologies of pregnant women of the maternity hospital, where I got a month and a half later, the first thing I was prescribed again magnesium drips. Oh, and the nurse suffered with me: for a long time she could not get into a vein. I was also tortured, punctured. As a result, the nurse called her colleague from intensive care, and she fell into a vein in one fell swoop. That's what experience means! But I spent a day with that catheter - blood came out of the vein. Put new catheter. Thank those, my droppers were canceled after 3 procedures and it was also quickly removed.

All catheters were opened in front of me. I didn’t buy one myself: there were no recommendations, and how do 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 ozovaya catheters - they are for long-term intravenous therapy. Once set 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 familiar in practice), the catheter should be provided with impeccable care. A well-chosen venous access is essential for successful intravenous therapy.

STEP 1. Choosing a puncture site

When choosing 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 insertion into 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 (for right-handers - left, for left-handers - right).
Use distal veins first
Use veins soft and elastic to the touch
Veins from the side opposite to surgical intervention.
Veins with the largest diameter.
The presence of a straight section of the vein along the length corresponding to the length of the cannula.

The most suitable veins and zones for the 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 in the veins of the lower extremities leads to an increased risk of thrombosis).
Places of bends of the limbs (periarticular areas).
Previously catheterized veins (possibly damage to the inner wall of the vessel).
Veins located close to arteries (possibility of arterial puncture).
Median cubital vein (Vena mediana cubiti). Puncture of this vein according to the protocols is permissible in 2 cases - blood sampling for analysis, in case of emergency assistance and poor expression of other veins.
Veins of the palmar surface of the hands (risk of damage to blood vessels).
Veins in a limb that has undergone surgery or chemotherapy.
Veins of the injured limb.
Poorly visualized superficial veins.
Fragile and sclerosed veins.
Areas of lymphadenopathy.
Infected areas and areas of skin damage.
Deep veins.

Table 1

Parameters and scope of various types of peripheral venous catheters

Color	Dimensions	PVC throughput	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 32-45mm)		Patients who undergo transfusion of blood products (erythrocyte mass) in a planned manner.
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 19mm)
Violet	26G (0.6 x 19mm)		Oncology, pediatrics, thin sclerosed veins.

STEP 2. Choosing the type and size of the catheter

When choosing a catheter, it is necessary to focus on the following criteria:

Vein diameter;
The required rate of introduction of the solution;
Potential residence time of the catheter in the vein;
Properties of the injected solution;
The cannula should never completely block 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 the introduction of drugs without additional puncture. With its help, needle-free bolus (intermittent) administration of drugs without interrupting intravenous infusion is possible.

In their structure, there are always such basic elements as a catheter, a guide needle, a plug and a protective cap. With the help of a needle, a venesection is performed, at the same time a catheter is inserted. The plug serves to close the catheter opening when infusion therapy is not performed (in order to avoid contamination), the protective cap protects the needle and catheter and is removed immediately before manipulation. For easy introduction of the catheter (cannula) into the vein, the tip of the catheter has the form of a cone.

In addition, catheters can be accompanied by an additional structural element - "wings". With their help, PVCs are not only firmly fixed to the skin, but also reduce the risk of bacterial contamination, since they do not allow 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 vein kit, including several catheters of various diameters;
Check the integrity of the packaging and the shelf life of the equipment;
Make sure that in front of you is the patient who is scheduled for vein 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 an opportunity to ask questions, determine the patient's preferences for the place where the catheter is placed;
Prepare a sharps disposal container within easy reach;
Wash your hands thoroughly and dry them;
Apply a tourniquet 10-15 cm above the intended area of catheterization;
Ask the patient to squeeze and unclench the fingers of the hand to improve the filling of the veins with blood;
Select a vein by palpation;
Remove the tourniquet;
Select the smallest catheter considering: vein size, rate of infusion required, intravenous therapy schedule, infusate viscosity;
Re-treat your hands using antiseptic and put on gloves;
Apply a tourniquet 10-15 cm above the selected zone;
Treat the catheterization site with a skin antiseptic for 30-60 seconds without touching untreated skin areas, let it dry on its own; DO NOT palpate the vein again;
Fix the vein by pressing it with your finger below the intended insertion site;
Take the catheter of the selected diameter using one of the grip options (longitudinal or transverse) and remove the protective sheath. If there is an additional plug on the case, do not throw the case away, but hold it between the fingers of your free hand;
Make sure the cut of the PVC needle is in the up 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;
When blood appears in the indicator chamber, the further advance of the needle must be stopped;
Fix the stylet needle, and slowly move the cannula from the needle into the vein to the end (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 to reduce bleeding and permanently remove the needle from the catheter;
Dispose of the needle in a safe manner;
If, after removing the needle, it turned 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, collect 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 attach an infusion line;
Fix the catheter on the limb;
Register the vein catheterization procedure according to the requirements of the medical institution;
Dispose of waste in accordance with the safety regulations and the sanitary and epidemiological regime.

Standard kit for peripheral vein catheterization:

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

STEP 4. Removal of the venous catheter

Wash your hands
Stop infusion or remove protective bandage (if present)
Sanitize your hands and put on gloves
From the periphery to the center, remove the fixation bandage without using scissors
Slowly and carefully remove the catheter from the vein
Gently press 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 fix it with a bandage. Recommend not to remove the bandage and not to wet the catheterization site during the day
Check the integrity of the catheter cannula. If there is a thrombus or catheter infection is suspected, 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 regulations and sanitary and epidemiological regime

Venous catheter removal kit

Sterile gloves
Sterile gauze balls
Adhesive plaster
Scissors
Skin antiseptic
trash tray
Sterile tube, scissors, and tray (used if catheter is clotted or catheter infection is suspected)

STEP 5. Subsequent venipunctures

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

The catheterization site is recommended to be changed 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 to enter. Avoid repeatedly touching the equipment with your hands. Strictly observe asepsis, work only with sterile gloves.
Change sterile plugs frequently, never use plugs that may have been contaminated on the inside.
Immediately after the introduction of antibiotics, concentrated glucose solutions, blood products, flush 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, catheter obstruction, leakage, as well as pain during the administration of drugs, notify the doctor and remove the catheter.
When changing the adhesive bandage, it is forbidden to use scissors. There is a danger for the catheter to be cut off, which will cause the catheter to enter the circulatory system.
To prevent thrombophlebitis, apply a thin layer of thrombolytic ointments to the vein above the puncture site (for example, Traumeel, Heparin, Troxevasin).
The catheter should be flushed before and after each infusion session with heparinized solution (5 ml of isotonic sodium chloride solution + 2500 IU of heparin) through the port.

Possible complications:

Despite the fact that peripheral vein 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 with good nursing technique, strict adherence to 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 the air from all plugs, additional elements and "droppers" before joining the PVVC, and also to stop the infusion before the vial or bag with the drug solution is empty; use IV devices of appropriate length to allow the end to be lowered below the insertion site, thus preventing air from entering the infusion system. An important role is played by reliable sealing of the entire system. The risk of air embolism during peripheral cannulation is limited by positive peripheral venous pressure (3-5 mm of water column). Negative pressure in the peripheral veins can be formed when choosing a location for the installation of PVCs above the level of the heart.
Hematoma associated with catheter removal	Apply pressure to the venipuncture site after removal of the catheter 3-4 min. or raise a limb.
Hematoma associated with PVK placement	It is necessary to ensure adequate filling of the vein and carefully plan the venipuncture procedure, do not puncture poorly contoured vessels.
Thromboembolism	Venipuncture of the lower extremities should be avoided, and the smallest possible diameter of the PVVC should be used, which ensures continuous blood washing of the tip of the catheter located in the vessel.
Phlebitis	The aseptic technique of installing the PVVC should be used, 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; replace PVVC every 48-72 hours or sooner (depending on conditions) and alternate side of the body for the site of the catheter.

STEP 7. Caring for your central catheter

Puncture catheterization of the central vessels is a medical manipulation. The subclavian vein, jugular and femoral veins can be punctured, both on the left and on the right. A central venous catheter can function and be uninfected for many weeks. This is achieved by strict adherence to the rules for caring for the catheter, including observing the rules of asepsis during its installation, precautions when performing infusion and injections.

With a long stay of the catheter in the PV, the following complications may occur:

thrombosis of a vein;

thrombosis of the catheter;

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, wash your hands with soap and water, dry them and treat them with 70% alcohol, 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 bandage is changed daily and as it gets dirty.

4. Before starting infusion therapy, ask the patient to inhale and hold his breath. Remove the rubber plug, attach a syringe with 0.5 ml of saline to the catheter, pull the plunger 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, adjust the frequency of drops. Pour the blood from the syringe into the tray.

5. After the end of infusion therapy, it is necessary to put a heparin lock as follows:

Ask the patient to inhale and hold the 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 a solution with an intradermal needle: 2500 IU (0.5 ml) of heparin + 4.5 ml of saline;

Secure the stopper to the catheter with adhesive tape.

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

After a jet injection of the drug through a catheter;

When blood appears in the catheter.

7. It is forbidden to kink the catheter, apply clamps that are not provided for by the design of the catheter, or allow air to enter the catheter.

8. In case of detecting problems associated with the catheter: pain, swelling of the arm, wetting of the bandage with blood, exudate or infusion medium, fever, kinks of the catheter, immediately inform the attending physician.

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

10. It is forbidden to leave the territory of the hospital with a catheter! In the case of referral to another medical institution, the patient must be accompanied by a health worker; in the discharge summary, a note is made that the patient has a subclavian catheter.

V.L. GOLOVCHENKO, L.M. ROMANOV