Teacher Nie's tone is always like a pool of lake water, calm and without ripples, fully reflecting the pediatric surgeon's extraordinary calmness.
Like Teacher Tan and Senior Brother Tao, they never encouraged her to do something just because she was timid. In this regard, Teacher Nie really showed another kind of bossy style. The anxiety in her heart seemed to be smoothed out by Teacher Nie's calm eyes. Xie Wanying calmed down and prepared to take action.
The internal jugular vein and the external jugular vein differ by only one letter, but they are worlds apart. One is the superficial vein and the other is the deep vein. The internal jugular vein, as a deep vein, runs deep in the muscle and is much more difficult to find than the superficial veins that can be clearly seen with the naked eye in the superficial fascia layer. Being difficult to find means that the difficulty of puncture increases exponentially.
Only doctors can perform deep vein puncture like this.
The success rate of puncturing invisible vessels can be significantly improved if ultrasound guidance is available. There are no such conditions for on-site first aid, so doctors can only rely on their own experience and understanding of anatomy.
From the perspective of specific anatomical position, the internal jugular vein is adjacent to the outside of the internal carotid artery, so the textbook states that the internal carotid artery must be found first.
Recalling the steps in the book and teaching video, Xie Wanying carefully used clothes to prop up the child's shoulders.
Because it is best to perform internal cervical puncture in a high position rather than a low position, that is, to raise the position of the child's shoulder strap for puncture. This is because during puncture, if low-level puncture fails, it is more likely to cause more terrible consequences such as hemothorax, and it is not easy to detect. The high position is relatively better. Even if it is punctured, most of the time it is just local skin hematoma.
Gently tilt the child's head back slightly to expose the child's small neck.
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Put on gloves and gently touch the center of the child's neck with your fingers, and you will feel the most obvious bony protrusion. This is what people commonly call the Adam's apple, and its anatomical counterpart is the thyroid cartilage.
Touching downward from the thyroid cartilage, the first bony protrusion you feel in order is the cricoid cartilage.
Run your finger across the horizontal line of the cricoid cartilage and you will soon feel an arterial pulsation point, which is the internal carotid artery.
After determining the location of the internal carotid artery, simply insert the needle laterally and parallel to it.
After her fingers determined the location of the internal jugular vein, Xie Wanying looked up and asked the teacher with her eyes whether her positioning was wrong.
"That's right." Nie Jiamin nodded, a hint of smile appeared in her silent dark eyes, and she continued to say to her in a gentle tone, "You did a good job, there's 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 the nerves are relaxed, the movements become smoother.
Disinfection and laying sheets.
Nie Jiamin on the opposite side helped her tilt the child's head to the left and fixed it in place 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.
The needle should be inserted at an angle of a little more than 30 degrees. The following steps are similar to the subclavian vein puncture, which is also a central venous puncture. After puncture, venous blood is withdrawn, a guide wire is inserted, the skin is broken, and then fixed.
Recalling the subclavian vein puncture she had performed before, Xie Wanying knew very well that as long as the first needle could be accurately inserted into the internal jugular vein, there would be nothing to worry about.
"Are you ok?" Nie Jiamin looked at her focused face, a slightly serious look in his eyes, not sure whether she was ready or not.
"Yes." Xie Wanying answered, her eyes flashed, and she moved her hands to insert the needle.
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