During venous puncture and perfusion

When puncturing the sub-clavicular or internal jugular vein, needle progression must be made while carefully maintaining the vacuum, and the lumen of the needle must be obstructed when disconnecting the syringe. The patient should be placed with the head lowered and, if controlled ventilation is provided, end expiratory positive pressure should be maintained. After insertion, catheters and tubing must be firmly affixed to avoid accidental disconnection, particularly during changes in position.

Infusion pumps require very close surveillance because there are no absolutely safe procedures57. They should include a safety device to detect bubbles in the tubing.

Central venous catheter removal should be done with the patient in a supine position and the head lowered. Dressings must be airtight to avoid air penetrating the fibrous channel created by longer term catheters.

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