floating catheter intubation

Hemodynamic monitoring of critically ill patients with acute left ventricular dysfunction, respiratory failure, severe shock, and perioperative monitoring of patients with severe heart disease, in order to correctly understand the evolution of the disease, determine the efficacy and prognosis, and determine treatment measures. Treatment of diseases: acute cardiac insufficiency Indication Hemodynamic monitoring of critically ill patients with acute left ventricular dysfunction, respiratory failure, severe shock, and perioperative monitoring of patients with severe heart disease, in order to correctly understand the evolution of the disease, determine the efficacy and prognosis, and determine treatment measures. Surgical procedure 1. Floating catheter intubation is performed under continuous monitoring of ECG and blood pressure (preferably invasive arterial blood pressure). 2, the path is now mostly through the internal jugular vein or femoral vein puncture intubation, there are also venous incision puncture before the elbow. 3, body position and puncture method see "intracervical vein and femoral vein puncture". 4. Placement of the floating catheter puncture sheath sheath The puncture needle and the catheter are placed in the order of operation, and the vein dilator is placed in the percutaneous puncture sheath sheath tube in the direction of the one-way flap. After confirming that the 18th needle is in the vein, remove the syringe, quickly insert the guide wire 12-15cm along the needle hole, take out the puncture needle, leave the guide wire in the vein, and cut the skin along the wire with a small sharp knife. The subcutaneous tissue was separated by a small mosquito clamp using a small incision. A percutaneous sheath sheath with a venous dilator is placed along the wire into the vein. Since the length of the venous dilator is longer than that of the percutaneous puncture sheath, the catheter is first placed into the blood vessel along the wire when the tube is placed, and then the venous dilator is slowly fed into the sheath tube. Once the sheath sheath is placed into the blood vessel, the venous dilator and the guide wire are pulled out and the blood is withdrawn from the bypass infusion tube connected thereto to reconfirm whether it is in the vein. 5. Placement of the floating catheter The pulmonary artery pressure measuring tube of the floating catheter with the protective sleeve is connected to the monitor and displays the pressure waveform. A floating catheter is placed along the floating catheter to puncture the one-way flap of the sheath sheath. If the catheter is placed through the internal jugular vein, the catheter is placed 20 cm, and the balloon is injected with carbon dioxide or filtered air 1.5 ml. At 20-25 cm, the waveform of the catheter into the right atrium can be seen. Continue to slowly push the catheter by hand. After the catheter enters the right ventricle through the tricuspid valve, the pressure suddenly rises. The descending branch quickly returns to the right ventricular waveform of zero point, and then continues to the forward tube. After the catheter enters the pulmonary artery, the systolic blood pressure is similar. The waveform of pulmonary artery pressure with elevated right ventricular pressure and diastolic blood pressure continues to advance, and there is a pressure waveform with no obvious difference between the ascending branch and the descending branch, which is the pulmonary capillary pressure. After seeing the pulmonary capillaries, the balloon deflation becomes pulmonary artery pressure, and then the balloon is re-inflated to become a pulmonary capillaries, suggesting that the position of the floating catheter is satisfactory. Record the length of the catheter entry and protect the puncture site with a disposable film or sterile dressing to prevent infection. 6. Connect the various conduits and monitor the CVP pressure measuring tube to the pressure sensor and monitor to monitor the CVP; the other end of the thermistor is connected to the cardiac output measuring instrument to continuously monitor the pulmonary blood temperature and pass the CVP. A certain amount of cold physiological saline was injected into the pressure measuring hole, and the cardiac output was measured by a thermodilution method, and then used to calculate other hemodynamic parameters. The bypass infusion tube connects the fluid, enters the fluid as needed and prevents thrombosis within the catheter sheath.