Procedure – Internal Jugular Catheter
After the 1st internal jugular catheter(IJC) a.k.a. triple lumen I inserted on Saturday under Dr. C’s guidance, I was given another chance today to practice what I have been taught! It came about simply because one of the patient in my cubicle needs it. I was so excited, happy at the same time that Dr. H & Dr. Z actually trusted me to do it by myself. But of course I knew I had to find another more experienced H.O (N, the well-known procedure expert among HOs) to help me(anyway, everyone needs an assistance for this, to at least hold the patient still or touch the non-sterile materials).
The procedure went on very smoothly, unlike the 1st attempt(where the patient had smaller veins, even Dr.C had difficulty accessing the good flow vein). This time, when I prick in to inject the lignocaine, I went a little too deep and while I withdraw the plunger, there was blood(good sign), so I confirmed that this will be where I am going to prick later with the large bore needle to access the *internal jugular vein. I withdrew the needle back a little and injected the lignocaine just under the skin. Large needle was then inserted, good flow was obtained immediately when I punctured the same site. I tested the flow a few times, ensure that it’s not arterial blood, then, followed by quickly inserting the guide wire, dilator and finally the triple lumen catheter. Lastly was the suturing to secure the catheter in place and a chest x-ray to confirm that it wasn’t inserted too deep in(like my 1st time) or to ensure that the lung is not punctured causing an iatrogenic pneumothorax. The x-ray came out alright, just like the way I expected it to be.
I felt successful, happy, instant satisfaction and confidence. Anyway, it has been said time and again that inserting triple lumen is 30% luck(which is a lot) and the rest is skill. Probably luck happened to be on my side today. 
*Internal jugular vein – the large vein in the neck, lateral(away from midline) to the prominent neck pulse
