CHAPTER 25 Central Venous Catheterization and Pressure Monitoring
1 Define central venous catheterization
Central venous catheterization involves inserting a catheter into the venous circulation and advancing it so its distal orifice is positioned immediately adjacent to or within the right atrium of the heart (Figure 25-1).
6 Describe the internal jugular vein approach
Low anterior: Locate the point at which the sternal and clavicular heads of the sternocleidomastoid muscle join. Introduce the needle at this point and direct it at a 30-degree angle to the skin. Advance the needle toward the ipsilateral nipple until venous blood is aspirated.
High anterior: Palpate the carotid artery at the level of the cricothyroid membrane. Introduce the needle just lateral to the carotid pulsation and advance it toward the ipsilateral nipple at a 30-degree angle until venous blood is aspirated. This approach frequently requires penetration of the sternocleidomastoid muscle by the introducer needle.
Posterior: Locate the junction of the posterior border of the sternocleidomastoid muscle and the external jugular vein. Introduce the needle just posterior to this point and advance it along the deep surface of the muscle toward the ipsilateral corner of the sternal notch until venous blood is aspirated.