Overview of Scalp Vein Catheterization
A peripheral intravenous (IV) catheterization is a common medical procedure done by healthcare professionals. This procedure allows doctors to take blood samples and deliver fluids or medicines into a patient’s bloodstream. Most often, the IV is placed in the arm or leg, but sometimes, the veins in the scalp can also be used.
Even though scalp IVs aren’t used as often, they can be quite efficient and safe. Knowing the unique factors involved in scalp-based IV access ensures it can be used effectively. This adds another choice for doctors when they need to perform this procedure.
Anatomy and Physiology of Scalp Vein Catheterization
Veins have the important role of carrying blood that lacks oxygen back to the heart. This is part of the body’s circulation system. Veins positioned just under the skin are easy to reach and are used for gaining access to the circulation system. The veins in the scalp on the head are a great example of this as they are just under the skin and easy to see, making it useful for inserting a catheter, a small tube used in medical procedures.
The main veins on the scalp which we use for these procedures are the posterior auricular, superficial temporal, and frontal veins such as the supratrochlear and supraorbital veins.
The supratrochlear and supraorbital veins, together known as the frontal veins, are situated on the forehead. The supratrochlear vein drains blood from the muscles and skin covering the forehead and front section of the scalp, areas where the supratrochlear artery delivers blood containing oxygen. This vein then flows into the angular vein.
The supraorbital vein also starts on the forehead. This vein drains blood from the forehead, eyebrow, and upper eyelid. It’s located just over the frontal bone and near the frontalis muscle before splitting to join the supratrochlear vein below and the superior ophthalmic vein, located near the inner corner of the eye.
The superficial temporal vein has branches in the frontal and parietal (upper side) sections of the head. It drains the muscles and skin of the area at the side of the head, known as the temporal region. This vein begins from a network of small veins on the side of the head, and runs sideways from the temporal area over the zygomatic arch (the bone on the side of the skull) and enters the parotid gland (a type of saliva gland) where it becomes the retromandibular vein. Eventually, it combines with the transverse facial vein.
The posterior auricular vein helps drain the muscles and skin of the scalp. It starts from small vessels behind the ear and joins with the occipital vein, located in the lower back part of the skull. This vein runs right behind the ear where it receives blood from the branch of the retromandibular vein, before turning into the external jugular vein, which is located in the neck.
The occipital vein drains the muscles and skin of the occipital area, located at the back of the scalp. It starts by small vessels at the back of the skull and lies close to the occipital artery. It connects with the superficial temporal vein and the posterior auricular vein to eventually turn into the external jugular vein in the neck.
Why do People Need Scalp Vein Catheterization
Putting a tube into a vein in the scalp, also known as ‘scalp vein catheterization’, is a way for doctors to take blood samples, or give fluids, blood products, or medicines directly into the bloodstream. This is similar to what’s done with peripheral IV catheterizations, which are usually done in the arms or legs.
So why might a doctor decide to use a vein in the scalp instead? Here are a few reasons:
- Young patients who need IV fluids or medicines but doctors can’t get access to their veins in the arms or legs.
- Patients who don’t have arms or legs (like with a condition called ‘phocomelia’) or for some other reason can’t have a peripheral IV placed in those areas.
- When small tubes need to be used for a short period of time (72 hours or less).
- When treating abnormal connections between arteries and veins in the scalp, also known as ‘arteriovenous malformations’.
Overall, using a vein in the scalp is a helpful way for doctors to give treatment or track a patient’s health when the usual methods aren’t possible or practical.
When a Person Should Avoid Scalp Vein Catheterization
There are a few situations that make placing a tube, or catheter, into a scalp vein less safe or not recommended:
If there is a skin infection around the area where the procedure will be done, it is generally avoided to prevent the risk of spreading the infection. Similarly, if a person has inflammation and clotting of a vein, known as thrombophlebitis, at the area where the catheter is supposed to be inserted, it is not recommended.
Care should also be taken to ensure that the patient is comfortable during the procedure, and while the catheter is in place. Any potential changes in sensation or movement around the area where the catheter is placed should also be monitored. Before going ahead with this procedure, it’s important to weigh up the potential risks and benefits, like any medical procedure.
Despite all of these considerations, getting access to a vein using a catheter can be critical, especially in emergency situations. It allows life-saving treatments like medications, fluids, and blood products to be given quickly and when needed most.
Equipment used for Scalp Vein Catheterization
If you need a scalp vein catheterization, this means your doctor needs to place a small tube into a vein in your scalp. This might be needed to give you medicine, hydrate you with fluids, or take a blood sample. Here is what your doctor typically uses during this procedure:
- Gauze – a type of fabric used to cover and protect the skin where the tube will be inserted.
- Gloves – used by the doctor for hygiene and protection.
- Hair clippers – used to trim the area of hair where the tube will be inserted.
- Chlorhexidine or alcohol swabs – used to clean the skin before the procedure to prevent infection.
- An elastic tourniquet of thin caliber (like a small rubber band) – used to make your veins fuller and easier to find.
- An IV catheter – this is a small tube that goes into your vein. The doctor will pick the smallest one available that’s also short (usually 0.75 inches) to minimize discomfort. Sometimes, another type of catheter called a catheter-over-needle may be used, but this needs additional tubing.
- Transparent film dressing – used to protect the area where the tube was inserted and keep it clean.
- Tape – used to secure the tube so it doesn’t move or fall out.
- Syringe – used to collect blood if it’s necessary for tests.
- Saline flush – a sterile saltwater solution used to clear the tube.
- IV tubing – connects the catheter to a bag of fluids or medications that need to be administered.
- Tubing extension set – used if additional length for the tubing is required.
- Saline lock – a device that allows the catheter to be closed but can be reopened for repeated access to administer fluids or medications.
All these items will help ensure that your procedure is done correctly and safely.
Who is needed to perform Scalp Vein Catheterization?
Putting a catheter (a thin, flexible tube) into a vein in your scalp is a specialized procedure and needs to be done by someone with specific training and a lot of experience in putting catheters into veins (also known as IV catheterization). Scalp veins are not usually used for inserting a catheter, so it’s especially important to make sure the person doing the procedure is very skilled.
Sometimes the need to put a catheter in a scalp vein is urgent, so it’s even more crucial that the person carrying out the procedure has a lot of experience. This job might be done by a technician, a medic, a nurse, or another qualified healthcare professional.
If the patient is a child, extra trained staff might be needed to help hold the child still, and a child life specialist (someone trained in helping children cope with stress and anxiety in medical settings) might be there to distract the child or offer support that’s suited to their age and understanding.
Preparing for Scalp Vein Catheterization
When undergoing scalp vein catheterization, it’s crucial for medical professionals to follow safety measures and sterile methods. The scalp vein catheterization is a medical procedure where a thin tube (catheter) is inserted into a vein in the scalp. This is popularly performed in children and adults for whom other veins may not be accessible or suitable. Simple steps medical professionals take during the procedure include keeping movements to a minimum, ensuring the head is correctly positioned, and carefully choosing the right location for the catheter.
The first step is to choose a suitable vein that has enough size to accommodate the catheter. They avoid veins that are likely to cause issues. Ideally, they pick a vein that is relatively straight; twisty veins can make the process more difficult. Undertaking this approach ensures the process is efficient and limits problems during catheterization.
Before the procedure, the doctor examines all the visible veins on the patient to decide the best place for the catheter. They check seven main areas in the following order: the inside ankle, the outside ankle, behind the knee, the back of the hand and wrist, the front of the elbow, the front of the scalp, and the back of the scalp. Sometimes, to better see the veins, they use special near-infrared technology.
Sometimes, medical professionals use ultrasound, performed by trained people, to help make the scalp vein catheterization more successful. The ultrasound allows them to visualize and assess the veins better and guide the catheter accurately.
How is Scalp Vein Catheterization performed
For placing a catheter in the scalp, it’s a good idea to use an elastic band around the head. The band should be put behind the spot where the catheter will go, but make sure it doesn’t squeeze the ears or eyes. An assistant can help to apply a gentle pressure with the band. Doing this makes the vein pop out and easier to see. In some cases, you may need to apply a light pressure just below the spot where the needle will enter, using your free hand.
If the chosen spot is hairy, it might be necessary to cut or shave it off. This will allow for better visibility and also helps to reduce chance of scars. Before beginning, it’s very important to clean the area thoroughly using alcohol or a chlorhexidine solution. This helps to prevent any infection. Make sure you always wear gloves and maintain clean techniques throughout the process.
Once the spot is picked and cleaned, remove the cover from the catheter and line it up with the selected vein. Keep the sharp end of the needle facing up at an angle around 30 degrees and push it through the skin towards the vein. Continue in this direction until you see some blood in the chamber of the needle, which means you have successfully entered the vein. Now, lower the angle of the catheter to about 10 degrees and push it further into the vein. With the catheter in place, pull out the needle while keeping the catheter steady. Press gently on the vein below the catheter to stop any blood from coming out.
You might want to secure the catheter with a clear dressing. After this, you can connect any necessary equipment such as a syringe or IV line to the catheter. Flush the catheter with saline to make sure it’s working properly. Check the area for any fluid leakage and to ensure the catheter is in the right place. Protect the area under the catheter with a piece of gauze to prevent any pressure on the scalp and secure it with tape. Since the shape and movements of the head might unsettle the catheter, you might want to protect it by securing it with a plastic cup. You can do this by using a medical cup — cut it to the right size and use tape to secure it over the catheter.
Possible Complications of Scalp Vein Catheterization
When a vein in the scalp is used to insert a catheter (a thin tube) for medical treatment, it usually goes smoothly. However, just like with any other procedure where a catheter is placed into a vein through the skin, there can be some difficulties. These issues can include:
* Pain – the patient may feel uncomfortable where the catheter is inserted.
* Bleeding or a build-up of blood under the skin, known as a hematoma.
* Local infection – an infection at the spot where the catheter went in.
* Occlusion, which basically means the catheter gets blocked.
* Extravasation of fluids or medication – this is when the fluids or medicines supposed to enter the vein instead leak out into the surrounding tissue.
* Inflammation and clotting in the vein (phlebitis and thrombophlebitis).
* Bloodstream infection – an infection that spreads through the blood.
* Damage to deeper structures or the surrounding tissues, including nerves.
* Embolism – this is when a clot, air, fatty material or other substance gets stuck in a blood vessel.
* The presence of air inside the skull.
* Infection in the space that surrounds the spinal cord (epidural space).
* Introduction of air into the cavernous sinus, which is a large vein at the base of the brain.
Remember that the medical team takes many precautions to prevent these complications, and they’re well trained to deal with them if they occur.
What Else Should I Know About Scalp Vein Catheterization?
Putting an IV (intravenous) line in is a really important procedure that helps doctors give medication and fluids into a patient’s vein. Sometimes, when it’s difficult to place an IV in the arms or legs, doctors might decide to use a vein in the scalp instead. This method is equally reliable and safe to use, especially if the patient does not have usable veins in their arms or legs and more aggressive methods are not necessary.
The doctors can even put a special kind of IV, called a peripherally inserted central catheter (PICC), into the scalp veins. This is just as safe and effective as inserting it into other parts of the body.
In some specific cases, giving a one-time dose of a certain medicine called vancomycin to babies before removing their IV line can help decrease the chance of them getting an infection in their blood, known as sepsis.