Sheath introducer

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
• 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 transvenous cardiac pacemakers

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
  • Central line: internal jugular
  • Central line: subclavian
  • Central line: supraclavicular
  • Central line: femoral
  • Pediatric central line
  • Sheath introducer
• Rapid infusion catheter (RIC)
• 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