A 45-year-old woman is admitted to the intensive care unit with septic shock requiring vasopressor support. The physician prepares to place a right internal jugular central venous catheter using the Seldinger technique. After proper sterile preparation, draping, and administration of local anesthesia, arrange the following steps in the correct chronological sequence for inserting the catheter.
- 1Puncture the internal jugular vein with the introducer needle under ultrasound guidance.
- 2Thread the guidewire through the introducer needle into the vein.
- 3Remove the needle and advance the tissue dilator over the guidewire.
- 4Remove the dilator, thread the central venous catheter over the guidewire, and remove the wire.
Cevap
The correct chronological sequence for the Seldinger technique is: needle puncture, guidewire insertion, tract dilation, and finally catheter placement.
The Seldinger technique universally requires initial needle puncture to locate and enter the vessel. This is followed immediately by guidewire insertion through the needle to secure the tract. The needle is then exchanged for a dilator over the wire to widen the tissue path. Finally, the dilator is removed and the catheter is passed over the wire, after which the wire is carefully extracted.
Adım Adım Çözüm
Anahtar Kavram
The Seldinger technique is the foundational method for safe vascular access, utilizing an initial needle puncture followed by a guidewire to maintain access while a tract is dilated for ultimate catheter insertion.