Puncture catheterization of the venous angle of Pirogov

Puncture and catheterization of the confluence of the internal jugular and subclavian veins (venous angle of Pirogov) is performed in the patient’s position, as with supraclavicular puncture of the subclavian vein. Standing at the head end of the table, the doctor pierces the skin in the corner between the collarbone and the sternal leg of the sternocleidomastial muscle, directing the needle under the sternoclavicular joint to a depth of 1.5-3 cm.

Puncture catheterization of the femoral vein

The method is used as a backup in cases where access to other veins is impossible due to wounds, burns, suppuration, frostbite, as well as when performing extracorporeal venovenous perfusion for the purpose of hemosorption, ultrafiltration, etc.

Technique: puncture and catheterization of the great saphenous and femoral veins is performed with the patient in the supine position, the thigh is slightly abducted and rotated outward. The pulsation of the femoral artery is determined 1-1.5 cm below the middle of the inguinal ligament and 1 cm inward from it, a puncture of the vein is performed from bottom to top at an angle of 45 degrees. in relation to the skin, while a stream of dark blood with a slight pulsation appears in the syringe with novocaine. Using the Seldinger method, a catheter is inserted into a vein through a needle to a depth of 1-1.2 cm and fixed. Complications may include accidental puncture of an artery, rupture of a vein, puncture of the posterior wall with the formation of a hematoma, thrombosis or thrombophlebitis, thromboembolism.

Puncture catheterization of the inferior vena cava and the mouth of the hepatic veins

The patient is positioned on his back, the hip can be slightly abducted and rotated outward. Below the middle of the inguinal ligament, the pulsation of the femoral artery is found and no more than 1 cm inward from it, soft tissues are anesthetized with novocaine, then the vein is punctured through a skin incision with a Saldinger needle posteriorly and upwards. The presence of dark venous blood entering the syringe in a non-pulsating or weakly pulsating stream indicates that the procedure is being carried out correctly. Under the control of an X-ray machine with an image intensifier, the catheter is passed through the iliac veins and the inferior vena cava and its curved tip is installed at the level of the X-XII thoracic vertebrae, blood pressure is measured, which normally ranges from 50-80 mm H2O, then a contrast agent is injected in a dose of 20-40 ml at a rate of at least 20 ml/sec. Moreover, 20-30 seconds before the start of contrast administration, the patient holds his breath while inhaling and tenses, due to which the pressure in the inferior vena cava increases and its contrast improves. Angiography can be simultaneous (shutter speed 0.5-1.0 sec) or serial (2-10 images within 1-5 sec). The inferior vena cava with a diameter of 25-35 mm is located to the right of the spinal column, projecting onto the right edge of the vertebrae and their transverse processes. The renal veins flow into it at the level of the I-II lumbar vertebrae, the left and middle hepatic vein in 70% of cases have a common anastomosis at the level of the XI-XII thoracic vertebrae, and the right hepatic vein is always independently at the level of the X-XI thoracic vertebrae. Along the 1st lumbar and 11th thoracic vertebrae, up to 10 or more small additional hepatic veins flow into the inferior vena cava, draining the right anatomical half and the 1st segment of the liver. The intraorgan distribution of the hepatic veins is quite diverse and does not always lend itself to systematization, and the anatomical relationships of their mouths are more constant.

Side effects and possible complications.

1. After puncture, there are always paravenous hematomas - if they are small, painless, relaxed and do not rise above the skin level, which is morphologically manifested by swelling of the venous wall or weak inflammatory infiltration, then they crumble within 5-6 days without visible consequences; if these hematomas protrude above the skin, are painful, compacted, which is morphologically manifested by an acute inflammatory change in all layers of the vein wall and perivenous tissue with the formation of intravenous thrombotic masses, then the resorption of such hematomas lasts about two weeks. Of course, the second occurs more often with repeated and multiple venipunctures. Physiotherapeutic procedures that most often give positive effects are shown here.

2. During punctures of the saphenous veins, their spasm may be observed, which more often occurs when the procedure is roughly performed and highly irritating substances are introduced into the intima of the vein. The spasmodic vein should be injected with a solution of novocaine and a warm compress should be applied.

PIROGOV VENOUS ANGLE

(n.i. pirogues) see Venous angle.

Medical terms. 2012

See also interpretations, synonyms, meanings of the word and what PIROGOV VENOUS ANGLE is in Russian in dictionaries, encyclopedias and reference books:

• CORNER in The Illustrated Encyclopedia of Weapons:
  ELEVATION - the angle between the direction of the axis of flight of the projectile and the elevation of the barrel. Varies from 0 to 90 e...
• CORNER in the Dictionary of Russian Railway Slang:
  car flow transferred from one system grade. station to another through transfers (from 1-2 to 8-10 per ...
• CORNER in the Dictionary of Thieves' Slang:
  - …
• CORNER in the Dictionary of Economic Terms:
  (slang) - monopolistic behavior of a company, consisting in controlling the volume of the total supply of goods; the price may rise until the appearance of...
• CORNER in the Bible Encyclopedia of Nikephoros:
  The said word is often found in the Holy Scriptures. Scripture in its ordinary sense (2 Chronicles 28:24); but is often used allegorically as well. So …
• CORNER in the Big Encyclopedic Dictionary:
  (flat) a geometric figure formed by two rays (sides of an angle) emerging from a single point (vertex of the angle). Any angle with a vertex at the center...
• CORNER in the Great Soviet Encyclopedia, TSB:
  flat, a geometric figure formed by two rays (sides of the surface) emerging from one point (vertex of the surface). Any U. that has a vertex in the center...
• CORNER in the Encyclopedic Dictionary of Brockhaus and Euphron:
  (mat.). — If we draw straight lines OA and 0B from point O on a given plane, we obtain angle AOB (Fig. 1). ...
• VENOUS
  relating to or located in a vein (for example, venous ...
• VENOUS in the Encyclopedic Dictionary:
  aya, oh Relating to vein, veins. Venous…
• CORNER in the Encyclopedic Dictionary:
  , corner, about the corner, on (in) the corner, m. 1. (in the corner.). In geometry: a flat figure formed by two rays (in 3 ...
• VENOUS in the Encyclopedic Dictionary:
  cm. …
• CORNER
  DIELECTRIC LOSS ANGLE, the angle at which the electric vector induction in the medium lags behind the voltage vector of the alternating electric. fields. Characterizes the dielectric. ...
• CORNER in the Big Russian Encyclopedic Dictionary:
  ANGLE OF ATTACK, the angle between the direction of the speed of translational motion of the body and the s.l. characteristic direction chosen on the body, e.g. at the wing -...
• CORNER in the Big Russian Encyclopedic Dictionary:
  ANGLE (flat), geom. a figure formed by two rays (sides of the U.) emerging from one point (the vertices of the U., Fig. a). Every U...
• CORNER* in the Brockhaus and Efron Encyclopedia:
  (mat.). ? If we draw straight lines OA and 0 B from point O on a given plane, we obtain angle AOB...
• CORNER
  y"goal, angles", angle", angle"in, angle", angle"m, y"goal, angles", angle"m, angle"mi, angle", angle"x, ...
• VENOUS in the Complete Accented Paradigm according to Zaliznyak:
  venous, venous, venous, venous, venous, venous, venous, venous, venous, venous, venous, venous, venous, venous venous, venous, venous, venous, venous, venous, venous, venous, venous, ...
• CORNER in the Popular Explanatory Encyclopedic Dictionary of the Russian Language:
  angle "a, z"a angle, n"a angle, about angle"e, in angle"y and in angle"e, on angle"y, m. 1) (in angle"e) In mathematics: ...
• CORNER
  It can be blunt, but if it’s straight, then...
• CORNER in the Dictionary for solving and composing scanwords:
  Two lines...
• CORNER in the Thesaurus of Russian Business Vocabulary:
  
• VENOUS in the New Dictionary of Foreign Words:
  (lat. venosus) adj. from the next vein; relating to or located in a vein, for example, v-aya ...
• VENOUS in the Dictionary of Foreign Expressions:
  [lat. venosus] adj. from the next vein; relating to or located in a vein, for example, v-aya ...
• CORNER in the Russian Language Thesaurus:
  ‘geometric figure’ Syn: vertex, corner…
• CORNER in Abramov's Dictionary of Synonyms:
  || head of the corner, from around the corner, bearish corner, open corner, all over...
• CORNER
  geometric figure Syn: vertex, corner...
• VENOUS in the Russian Synonyms dictionary:
  venny...
• CORNER
  1. m. 1) a) A geometric figure formed by two straight lines emanating from one point (in mathematics). b) Part of the plane enclosed between ...
• VENOUS in the New Explanatory Dictionary of the Russian Language by Efremova:
  adj. 1) Correlative in meaning. with noun: vein, connected with it. 2) Characteristic of a vein, characteristic of ...
• VENOUS in Lopatin's Dictionary of the Russian Language.
• CORNER in the Complete Spelling Dictionary of the Russian Language:
  angle, angle, sentence in (on) the corner and (mathematically) in ...
• VENOUS in the Complete Spelling Dictionary of the Russian Language.
• CORNER in the Spelling Dictionary:
  `angle, angular`a, sentence. in (on) the corner and (mathematically) in ...
• VENOUS in the Spelling Dictionary.
• CORNER
  area (usually remote) In a remote corner. Bearish u. (outback). angle In geometry: a flat figure formed by two rays N3 emanating from ...
• VENOUS in Ozhegov’s Dictionary of the Russian Language:
  <= …
• ANGLE in Dahl's Dictionary:
  husband. fracture, kink, knee, elbow, protrusion or crease (depression) on one side. A linear angle, any two opposing lines and an interval...
• CORNER in the Modern Explanatory Dictionary, TSB:
  (flat), a geometric figure formed by two rays (sides of an angle) emerging from one point (vertex of the angle). Any angle with a vertex at...
• CORNER
  corner, about the corner, on (in) the corner and (mat.) in the corner, m. 1. Part of the plane between two straight lines emanating from ...
• VENOUS in Ushakov’s Explanatory Dictionary of the Russian Language:
  venous, venous (anat.). Adj. to vein. Venous…
• CORNER
  angle 1. m. 1) a) A geometric figure formed by two straight lines emanating from one point (in mathematics). b) Part of the plane enclosed ...
• VENOUS in Ephraim's Explanatory Dictionary:
  venous adj. 1) Correlative in meaning. with noun: vein, connected with it. 2) Characteristic of a vein, characteristic of ...
• CORNER
  I m. 1. A geometric figure formed by two straight lines emanating from one point (in mathematics). Ott. Part of a plane enclosed between two...
• VENOUS in the New Dictionary of the Russian Language by Efremova:
  adj. 1. ratio with noun vein associated with it 2. Characteristic of vein, characteristic of ...
• CORNER
  I m. 1. A geometric figure formed by two straight lines emanating from one point (in mathematics). 2. Part of the plane, ...
• VENOUS in the Large Modern Explanatory Dictionary of the Russian Language:
  adj. 1. ratio with noun veins connected to it; coronal II 1.. 2. Characteristic of veins, characteristic of ...
• PIROGOV'S BANDAGE in Medical terms:
  see Pirogov bandage...
• PIROGOV VEST BANDAGE in Medical terms:
  see Pirogov bandage...
• PIROGOV SPACE in Medical terms:
  (n.i. pirogov) see Parony - Pirogova ...
• PARONY-PIROGOV SPACE in Medical terms:
  (f. parona, Italian surgeon of the 19th century; N.I. Pirogov, 1810-1881, Russian surgeon; synonym Pirogov’s space) cellular space in the lower third ...
• PIROGOV'S LYMPH NODE in Medical terms:
  Rosenmuller - see Pirogov - Rosenmuller lymphatic ...

2. The course of the vertebral artery, its sections.

Vertebral artery (a. vertabralis), the first branch extending from the subclavian artery immediately after it leaves the chest cavity in the interval between m. scalenus anterior and m. longus colli is directed into the cranial cavity. Along its course, the artery is divided into four parts. Starting from the superomedial wall of the subclavian artery, the vertebral artery is directed upward and somewhat posteriorly, located behind the common carotid artery along the outer edge of the long muscle of the neck (prevertebral part, pars prevertebralis).

Then it enters the opening of the transverse process of the VI cervical vertebra and rises vertically through the openings of the same name in all cervical vertebrae: the transverse process (cervical) part, pars transversaria (cervicalis).

Coming out of the opening of the transverse process of the second cervical vertebra, the vertebral artery turns outward; approaching the opening of the transverse process of the atlas, it is directed upward and passes through it (atlas part, pars atlantis). It then follows medially in the groove of the vertebral artery on the upper surface of the atlas, turns upward and, piercing the posterior atlanto-occipital membrane and the dura mater of the brain, enters through the foramen magnum into the cranial cavity, into the subarachnoid space (intracranial part, pars intracranialis).

In the cranial cavity they connect with each other, forming one unpaired vessel - the basilar artery, a. basilaris.

Ticket 75

1. Prescalene space of the neck: boundaries, contents. 2. Topography of the subclavian vein (course, depth, relative position of vascular-nervous elements, projection onto the skin of the vein), Pirogov’s venous angle.

1. Prescalene space of the neck: boundaries, contents.

The first intermuscular space - the prescalene fissure (spatium antescaleum) is limited in front and outside by the sternocleidomastoid muscle, behind - by the anterior scalene muscle, from the inside - by the sternohyoid and sterno-thyroid muscles.

In the prescalene space there is the lower section of the main vascular-nerve bundle (a. carotis communis, v. jugularis interna, n. vagus), the thoracic duct (on the left), the phrenic nerve p. phrenicus (but it already lies under the 5th fascia) and Pirogov's venous angle is the confluence of the internal jugular vein and the subclavian vein. The thoracic lymphatic duct flows into the left venous angle. The right lymphatic duct flows into the right venous angle. The thoracic lymphatic duct (HLD) is an unpaired formation. It is formed in the retroperitoneal space at the level of the 2nd lumbar vertebra. Two variants of the final section of the GLP at the point of its confluence with the venous angle are described: scattered and main.

The vein is separated from the subclavian artery by the anterior scalene muscle. The suprascapular artery, a suprascapularis, also passes through the prescalene interval in the transverse direction.

2. Topography of the subclavian vein (course, depth, relative position of vascular-nervous elements, projection onto the skin of the vein), Pirogov’s venous angle.

The subclavian vein can be divided into two sections: behind the clavicle and at the exit from under the clavicle in the trigonum clavipectorale. The vein is covered along the front by the collarbone. The subclavian vein reaches its highest point at the level of the middle of the clavicle, where it rises to its upper edge, then crosses the clavicle at the border of the inner and middle third of the clavicle and lies on the first rib. The subclavian vein starts from the lower border of the first rib and is a continuation of the axillary vein. The topography of the right and left subclavian veins is almost the same. At the lower edge of the middle third, the subclavian artery and vein are separated by the anterior scalene muscle. The artery is removed from the vein, which avoids mistakenly hitting the artery instead of the vein. At the same time, the artery separates the vein from the trunks of the brachial plexus. Above the clavicle, the vein is located closer to the dome of the pleura; below the clavicle, it is separated from the pleura by the first rib.

Immediately behind the sterno-clavicular joint, the subclavian vein (v. subclavia) connects with the internal jugular vein (v. jugularis interna), the brachiocephalic veins are formed on the right and left, which enter the mediastinum and, having united, form the superior vena cava. In front, the subclavian vein is crossed by the phrenic nerve; in addition, on the left, above the apex of the lung, the thoracic lymphatic duct passes into the venous angle formed by the confluence of the internal jugular and subclavian veins.

Venous angle of Pirogov

The confluence of the subclavian and external jugular veins is called the Pirogov venous angle. On the left, the thoracic (lymphatic) duct flows into the venous angle. On the surface of the body, the venous angle is projected onto the sternum-clavicular joint. All large veins of the lower half of the neck (external jugular, vertebral, etc.) flow into the venous angle.