Teacher Nie's tone is always like a lake, calm and calm, which fully reflects the excellent calmness of a pediatric surgeon.
Like Teacher Tan and Brother Tao, they never encourage her to do something just because she is more timid. Teacher Nie does show another kind of boss style in this regard. The anxiety in his heart seems to be smoothed away by Teacher Nie's calm eyes. Okay, 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 the difference is very different. One is the superficial vein and the other is the deep vein. As a deep vein, the internal jugular vein runs deep in the muscles, which is far better than what can be seen by the naked eye in the superficial fascial layer. Clearly visible superficial veins are much more difficult to find. Being difficult to find means that the difficulty of puncture is doubled.
Only doctors can perform deep vein puncture like this.
If ultrasound guidance is the best, 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 better to do it 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 during puncture, if the puncture fails at a low position, it is more likely to cause more terrible consequences of hemopneumothorax, and It’s not easy to find. The high position is much 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.
Feeling downward from the thyroid cartilage, the first bony protrusion in the sequence is the cricoid cartilage.
Draw your finger across the horizontal line of the cricoid cartilage, and soon you can feel another arterial pulse point, which is the internal carotid artery.
After determining the location of the internal carotid artery, just 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 did a good job, there is no need to worry."
At this time, Teacher Nie felt a bit like a kindergarten teacher. Xie Wanying couldn't help but feel relaxed. Once her nerves relaxed, she could move more freely.
Disinfect and spread the sheets.
Nie Jiamin, who was on the opposite side, 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 looked at the child's skin with her eyes.
It is judged that the needle should be inserted at an angle of more than 30 degrees. The following steps are similar to the subclavian vein puncture, which is also a central venous puncture. After the puncture, the venous blood is withdrawn, the guide wire 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 not clear whether she was ready.
"Yes." Xie Wanying replied, her eyes flashed, and she manually inserted the needle.