Sheath introducer: Difference between revisions
Elcatracho (talk | contribs) |
Elcatracho (talk | contribs) |
||
| Line 23: | Line 23: | ||
==Procedure== | ==Procedure== | ||
''Same procedure as [[central line]] placement according to site (see below) however the dilator must be pre-loaded into the line and the dilator-sheath is introduced over the wire simultaneously. Afterwards, the dilator and wire are removed together.'' | |||
**[[Central line: internal jugular]] | |||
**[[Central line: subclavian]] | |||
**[[Central line: supraclavicular]] | |||
**[[Central line: femoral]] | |||
==Complications== | ==Complications== | ||
Revision as of 14:26, 24 April 2021
Overview
- Long (6-8cm), wide bore (6-9 Fr) single lumen catheter typically placed in a central vein
- Have wide plastic hub on proximal end with one-way valve
- Can be used to insert triple lumen catheter, Swan-Ganz catheter, and temporary external pacing wires
- Commonly used for rapid fluid or blood administration (especially in trauma resuscitation)
- Can infuse close to 600 ml/min with pressure[1]
- Cordis and MAC are both trade names commonly used for sheath introducers
Indications
- High volume/flow resuscitation (e.g. hemorrhagic shock)
- Emergency venous access
- Inability to obtain peripheral venous access
- Repetitive blood sampling
- Administering hyperalimentation, vasopressors, caustic agents, or other concentrated fluids
- Insertion of pulmonary artery catheters
- Insertion of transvenous cardiac pacemakers
Contraindications
Equipment Needed
Procedure
Same procedure as central line placement according to site (see below) however the dilator must be pre-loaded into the line and the dilator-sheath is introduced over the wire simultaneously. Afterwards, the dilator and wire are removed together.
Complications
Complications vary by site
- Pneumothorax (more common with subclavian)
- Arterial puncture (more common with femoral)
- Catheter malposition
- Subcutaneous hematoma
- Hemothorax
- Catheter related infection (historically more with femoral)
- Catheter induced thrombosis
- Arrhythmia (usually from guidewire insertion)
- Venous air embolism (avoid with Trendelenburg position)
- Theoretically higher risk with sheath introducer compared to other CVC's
- Bleeding
See Also
Vascular access types
- Central venous catheterization
- Rapid infusion catheter
- Intraosseous access
- Venous cutdown
- Umbilical vein catheterization
- Ultrasound assisted peripheral line placement
- External jugular vein cannulation
- The "Easy IJ"
- Midlines
External Links
ETM Course: Large Bore Vascular Access Devices
References
- ↑ Brown, N., Kaylene M. Duttchen, and J. W. Caveno. "An evaluation of flow rates of normal saline through peripheral and central venous catheters." American Society of Anesthesiologists Annual Meeting, Orlando. Anesthesiology. 2008.