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

Vascular access types

External Links

ETM Course: Large Bore Vascular Access Devices

References

  1. 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.