Acesso venoso central

To begin, insert the introducer [music] needle into the target vein, preferably the right internal jugular.
Aspirate to [music] ensure proper placement.
Advance the guidewire until the tip resides [music] in the inferior vena cava or as far as is appropriate.
Remove the needle, [music] leaving the guidewire in place.
Enlarge the insertion site.
Make a small incision at the catheter [music] exit site on the chest wall to accommodate the cuff.
Use blunt dissection to create a tunnel opening in the subcutaneous tissue.
The distance of the tunnel should be [music] short enough to keep the Y hub of the catheter from entering the exit site, >> [music] >> but long enough to keep the cuff 2 cm from the skin exit site.
Pull back [music] the stylet tip into the catheter and attach the catheter to the tunneler.
Slide the tunneling [music] sleeve over the catheter so it covers the arterial hole.
Insert [music] the tunneler into the hub exit site and pull the tunneler and catheter through the subcutaneous tunnel to the venous insertion site.
Do not tunnel [music] through muscle.
Gently lead the catheter tunneler connection into the tunnel.
When tunneling [music] is complete, remove the tunneler from the catheter.
Do not pull the tunneler out at an angle.
Keep the tunneler straight [music] to prevent damage to the catheter tip.
Flush the arterial lumen of the catheter with [music] saline and clamp the extension.
Thread the dilator over the proximal end of the guidewire and advance [music] until it is in the target vein.
Remove the dilator, maintaining the guidewire's position.
Advance the stylet so that it protrudes from the [music] catheter tip.
Tighten the Luer lock of the stylet to the proximal end of the venous lumen.
Flush the stylet with [music] saline.
Thread the distal end of the stylet over the guidewire tip and advance the catheter [music] into the target vein until the catheter is correctly positioned.
Remove the stylet and guidewire from the venous lumen.
Attach [music] syringes to both extensions and open the clamps.
Blood should aspirate easily from both arterial and venous sides.
Both lumens should then be flushed with saline-filled syringes.
[music] Close the extension clamps, remove the syringes, and place an injection cap on each lure lock connector.
Confirm proper [music] tip placement with fluoroscopy.
Suture to secure the catheter [music] hub to the chest wall.
The unique design of ProGuide, specifically the apposition deflection feature or [music] bump, reduces the risk of it lying directly against the vessel wall or wall of the heart.
The benefit is that it provides smooth, uninterrupted [music] flow of blood through the catheter.