5. Central venous pressure
catheterization and
monitoring
Performed when
Necessary for procedure such as pulmonary artery
catheter or pacemaker placement
Peripheral vein cannot be cannulated
Desired for measurement of central venous
pressure
6. Central venous pressure
catheterization and
monitoring
Not performed in hypovolemic shock except
Massive volume repletion to elderly patients or
heart disease
Fluid administration monitored in patients with
visceral trauma & severe head injury
7. Central venous pressure
catheterization and
monitoring
Sites
Most common: placed in the superior vena cava
via internal jugular or subclavian vein
Less common: via external jugular vein or femoral
vein
Peripheral veins: brachial-basilic system
9. Venous access site
Cephalic vein
Superficial radial vein
at the wrist
Veins of the hand
Veins in the anticubital
fossa
The large basilic vein in
the upper arm
10. Venous access site
Deep femoral vein
Proximal great
saphenous vein in the
thigh
Superficial saphenous
vein at the ankle
46. Indications
•Immediate venous access for delivery of fluids, drugs or
blood products in patients cannot find out other site
• Recommended In PALS, ACLS
• CPR more than 2 mins or more than 2 attempt
68. Treatment
Venous access
Rapid volume infusion
To less volume changes during respiration
And increase RV pressure to counter with
pericardial pressure
These may prevent requirement for
pericardiocentesis
69. Pericardiocentesis
If hemodynamic instability observed,
Emergently performed underfluoroscopy or
echocardiographic guided
With/without comfirmatory testing with
agitated saline injection
Dramatical improvement is necessary
71. Contra-indication
Diagnosis is indoubt
Rupture true or false aneurysm
Rupture ventricular aneurysm
Severe local infection
72. Post drainage monitoring
Symptoms
Physical findings of decompensation
Blood pressure changes
Evidence of hypoperfusion
Pulsus paradoxus
Imaging
Chest X ray
Echocardiography
73. Indwelling catheter drainage
Catheter placement for 2-3 days
Could prevent recurrent even in idiopathic
effusion from 23% to 6% in 3 years
Immediately drainage for subsequent
decompensation
74. Indwelling catheter drainage
Instillation of diluted heparin required
Heparin 0.5 mL in PSS 9.5 mL
Except with hemopericardium e.g. dissection