Chapter 32 ■ Central Venous Catheterization 205

p. Visualize catheter entering common femoral vein to

ensure cephalad direction of catheter.

q. Obtain radiograph(s) to confirm position in inferior

vena cava, once estimated length is inserted (radiographic contrast material may be required).

r. Ligate vessel with caudad suture, and tie down

cephalad suture without occluding catheter.

s. Check for easy backflow of blood in catheter.

t. Flush catheter with 2.5 to 3 mL of heparinized

saline. If catheter is capped, while infant is transferred from operating room to intensive care unit,

clamp catheter while plunger of heparin syringe is

moving forward to ensure positive pressure in line to

prevent backflow and clotting of blood.

u. Close groin wound with subcuticular 5-0 absorbable

suture, taking care not to penetrate catheter with

needle.

v. Secure the catheter to the skin with at least one

nylon suture to hold it until the cuff has created

enough tissue ingrowth.

w. Cover with dressing of choice.

Fig. 32.11. Insertion of a catheter into the common facial vein. Incision is below

the angle of the mandible at the level of the hyoid bone. The facial vein is ligated at

the junction of the anterior and posterior tributaries. Alternatively, the subcutaneous tunnel may be made with a catheter exit site on the anterior chest wall. Inset:

The catheter is looped in the neck wound to “dampen” the effect of head movement. (Reproduced from Zumbro GL Jr, Mullin MJ, Nelson TG. Catheter placement in infants needing total parenteral nutrition utilizing common facial vein.

Arch Surg. 1971;102:71, with permission of American Medical Association.)

Fig. 32.12. Anatomic view of the site of incision for proximal

saphenous vein cutdown with underlying femoral triangle.