Teacher Nie's tone is always like a lake, calm and calm, which fully reflects the excellent calmness of a pediatric surgeon.
Teacher Tan and Brother Tao never encourage her to do something just because she is more timid. Teacher Nie does show another boss style in this regard. The anxiety in her heart seemed to be smoothed away by Teacher Nie's calm eyes. Xie Wanying calmed down and prepared to operate.
There is only one word difference between the internal jugular vein and the external jugular vein, but they are very different. One is a superficial vein and the other is a deep vein. As a deep vein, the internal jugular vein runs deep in the muscles and is much more difficult to find than the superficial veins that can be clearly seen with the naked eye in the superficial fascial layer. Being difficult to find means that the difficulty of piercing is doubled.
Only doctors can perform deep vein puncture like this.
It is best if ultrasound guidance is used, and the success rate of invisible blood vessel puncture can be significantly improved. On-site first aid does not have this condition, and doctors can only rely on their own experience and understanding of anatomy to operate.
From the specific anatomical position analysis, the internal jugular vein is next to the outside of the internal carotid artery, so the textbook says that the internal carotid artery must be found first.
Recalling the steps in the book and instructional video, Xie Wanying carefully lifted the child's shoulders and back with clothes.
Because when performing internal cervical puncture, it is best to perform the puncture in a high position rather than a low position, that is, to raise the shoulder strap position of the child to perform the puncture. This is because if a low puncture fails during puncture, hemopneumothorax is more likely to have more dire consequences and is less easy to detect. The high position is relatively better, even if the puncture is mostly just local skin hematoma.
Gently tilt the child's head back slightly to expose the child's neck.
Wearing gloves, I gently touched the front and center of the child's neck with my fingers, and found the most obvious bony protrusion. This is commonly known as the Adam's apple, and its anatomical counterpart is the thyroid cartilage.
From the thyroid cartilage down, the first bony protrusion in the sequence is the cricoid cartilage.
Draw your fingers across the horizontal line of the cricoid cartilage, and you can quickly feel another arterial pulse point, which is the internal carotid artery.
After determining the location of the internal carotid artery, simply insert the needle parallel to the outside.
Her fingers determined the location of the internal jugular vein. Xie Wanying raised her head and asked the teacher with her eyes whether her positioning was correct.
"That's right." Nie Jiamin nodded, a smile appeared in his silent black eyes again, and he continued to say to her in a gentle tone, "You are doing a good job, there is no need to worry."
At this time, Teacher Nie felt a bit like a kindergarten teacher to her. Xie Wanying couldn't help but feel relieved. Once my nerves are relaxed, I can move more freely.
Disinfect and spread the sheets.
Nie Jiamin, who was opposite her, helped her turn the child's head to the left and fix it to prevent the child's head from moving during the puncture.
Xie Wanying found and picked up the No. 22 trocar, connected the syringe, and stared at the child's skin.
It is sufficient to insert the needle at an angle of just over 30 degrees. The following steps are similar to subclavian vein puncture, which is also a central venous puncture. After the puncture, the venous blood is withdrawn, a guidewire is inserted, the skin is broken, and then fixed.
Recalling the subclavian vein puncture she had done before, Xie Wanying knew very well that as long as the first needle could be accurately inserted into the internal jugular vein, she would have nothing to worry about.
"are
you
OK?" Nie Jiamin looked at her focused face, with a slightly stern look in her eyes. It was unclear whether she was ready.
"Yes." Xie Wanying replied, her eyes flashed, and she manually inserted the needle.
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