Sheath introducer
Overview
- Long (6-8cm), wide bore (6-9 Fr) single lumen catheter typically placed in a central vein
- Have wide plastic hub on proximal end with one-way valve
- Can be used to insert triple lumen catheter, Swan-Ganz catheter, and temporary external pacing wires
- Commonly used for rapid fluid or blood administration (especially in trauma resuscitation)
- Can infuse close to 600 ml/min with pressure[1]
- Cordis and MAC are both trade names commonly used for sheath introducers
Indications
- High volume/flow resuscitation (e.g. hemorrhagic shock)
- Emergency venous access
- Inability to obtain peripheral venous access
- Repetitive blood sampling
- Administering hyperalimentation, vasopressors, caustic agents, or other concentrated fluids
- Insertion of transvenous cardiac pacemakers
Contraindications
Equipment Needed
Procedure
Complications
Complications vary by site
- Pneumothorax (more common with subclavian)
- Arterial puncture (more common with femoral)
- Catheter malposition
- Subcutaneous hematoma
- Hemothorax
- Catheter related infection (historically more with femoral)
- Catheter induced thrombosis
- Arrhythmia (usually from guidewire insertion)
- Venous air embolism (avoid with Trendelenburg position)
- Theoretically higher risk with sheath introducer compared to other CVC's
- Bleeding
See Also
External Links
References
- Brown, N., Kaylene M. Duttchen, and J. W. Caveno. "An evaluation of flow rates of normal saline through peripheral and central venous catheters." American Society of Anesthesiologists Annual Meeting, Orlando. Anesthesiology. 2008.
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