![]() But a longer blood access catheter was not available in our institute. Although the catheter advanced easily into the central vein, it was too short (16 cm) to reach the right atrium. ![]() On day 2, we inserted a triple‐lumen catheter (Gentle Cath™® COVIDIEN) via the left internal jugular vein under fluoroscopic guidance by emergency physician who is a nonvascular expert (Figure 1). An initial effort was made to obtain central access via ultrasound‐guided insertion of a triple‐lumen catheter into the right internal jugular vein this effort failed due to accidental arterial puncture. Given her clinical condition, we were concerned that conventional HD would be associated with a high risk of disequilibrium syndrome as such, CRRT was recommended. Upon admission, she was diagnosed with cerebral infarction by computed tomography (CT) and magnetic resonance image (MRI) that was treated via a thrombectomy. Her medical history was notable for chronic renal failure due to diabetic nephropathy that required regular hemodialysis (HD). The tip should be cut off with sterile scissors and dropped directly into a sterile specimen container.An 87‐year‐old woman was transported to our institute for evaluation and treatment of an acute disturbance of consciousness and right hemiplegia. When catheter-related infections are suspected, the catheter tip provides valuable information about infection sources in cases of sepsis. The site should be carefully inspected for inflammation, and any drainage should be cultured. Maintenance care procedures also should be fully documented. Documentation should include preprocedure and postprocedure physical assessment of the patient, catheter type and size, insertion site location, x-ray confirmation of the placement, catheter insertion distance (in centimeters), and the patient’s tolerance of the procedure. Health care professionals are responsible for preventing, assessing for, and managing central venous therapy complications (e.g., air embolism cardiac tamponade chylothorax, hemothorax, hydrothorax, or pneumothorax local and systemic infections and thrombosis). IV tubing and solutions and injection caps also should be changed as required by the agency’s protocol. Dressing changes are carried out using sterile technique. The catheter should be manipulated as infrequently as possible during its use. An antibiotic impregnated patch covered by a sterile dressing should be placed at the insertion site. After the catheter is inserted, it should be firmly sewn to the skin to keep it from migrating in and out of the insertion site. With or without radiological guidance, the best results are obtained by practitioners who perform the procedure frequently. Ultrasound guidance improves the likelihood of entering the desired vein without injury to neighboring structures. The skin should be prepared with chlorhexidine-gluconate (2%) or povidone-iodine. Sterile technique is a requirement during insertion. The subclavian approach to the placement of a central line is preferred, because femoral placements may be complicated by deep venous thrombosis, and internal jugular sites carry an increased risk of infection. Health care professionals must use caution to prevent life-threatening complications when inserting and maintaining a central line. ![]() ![]() A catheter inserted into the superior vena cava to permit intermittent or continuous monitoring of central venous pressure, to administer fluids, medications or nutrition, or to facilitate obtaining blood samples for chemical analysis. ![]()
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