Chapter 894 【894】You Are Doing Well

Teacher Nie's tone is always like a pool of lake water, calm and calm, which fully reflects the excellent calmness of pediatric surgeons.

Like Teacher Tan and Brother Tao, they never encourage her to do it just because she is more timid. Teacher Nie does show another kind of bossy demeanor in this regard. The restlessness in her heart seemed to be smoothed away by Teacher Nie's calm eyes. Xie Wanying calmed down and prepared to operate.

The difference between the internal jugular vein and the external jugular vein is only one word, but the difference is very far. One is a superficial vein and one is a deep vein. As a deep vein, the internal jugular vein runs through the deep layer of the muscle, and is far more difficult to find than the superficial vein that can be clearly seen with the naked eye in the superficial fascia layer. Difficult to find means that the difficulty of puncturing is multiplied.

Only doctors can perform deep vein puncture like this.

The success rate of invisible vessel puncture can be significantly improved if ultrasound guidance is optimal. 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 analysis of the specific anatomical position, the internal jugular vein is next to the outside of the internal carotid artery, so it is written in the textbook that the internal carotid artery must be found first.

Recalling the steps in the book and the teaching video, Xie Wanying carefully put the clothes on the child's shoulders first.

Because it is better to perform neck puncture at a high position rather than a low position, that is, the child should be padded with a shoulder strap for puncture. This is because when the puncture is performed, if the puncture fails at a low position, it is more likely to have more dire consequences, such as blood pneumothorax, and it is not easy to find. The high position is relatively better, even if most of the punctures are local skin hematomas.

Gently tilt the child's head back slightly, exposing the child's small neck.

Putting on the gloves, he gently touched the middle of the child's neck with his fingers, and found the most obvious bony protrusion. This is commonly known as the Adam's apple, which anatomically corresponds to the thyroid cartilage.

From the thyroid cartilage to the bottom, the first bony protrusion in the sequence is the cricoid cartilage.

Swipe your fingers across the horizontal line of the cricoid cartilage, and soon you can feel another arterial pulse point, which is the internal carotid artery.

Once the position of the internal carotid artery is determined, the needle needs only to be advanced laterally and parallel.

After confirming the position of the internal jugular vein with her fingers, Xie Wanying raised her head and asked the teacher if she had made a mistake.

"That's right." Nie Jiamin nodded, a smile appeared in his silent black eyes, and he continued to talk to her in a gentle tone, "You've done a good job, don't worry."

At this time, Teacher Nie felt a bit like a kindergarten teacher to her. Xie Wanying couldn't help feeling relieved. Once the nerves are relaxed, the movements become more free.

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 when the doctor punctured.

Xie Wanying found and picked up the No. 22 trocar, connected the syringe, and stared at the child's skin.

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 can be accurately inserted into the internal jugular vein, there is nothing to be afraid of.

"Are you ok?" Nie Jiamin looked at her focused face, with a slightly stern look in her eyes, not sure if she was ready or not.

"Yes." Xie Wanying replied, with a twinkle in her eyes, she manually inserted the needle.