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  Like Teacher Tan and Brother Tao, but she never encouraged her to do it because she was more timid. Teacher Nie did show another kind of bossy demeanor in this regard. The anxiety in her heart seemed to be smoothed out by Teacher Nie\'s quiet eyes, Xie Wanying calmed down and prepared to operate.

   The difference between the internal jugular vein and the external jugular vein is only one word, but the difference is very far. One is the superficial vein and the other is the deep vein. The internal jugular vein, which is a deep vein, is much harder to find than the superficial vein that can be clearly seen in the superficial fascia layer when walking in the deep layers of the muscle. Hard to find, which means that the difficulty of puncturing is multiplied.

   Like this deep vein puncture, only a doctor can perform it.

   If ultrasound guidance is best, the success rate of invisible vascular puncture can be significantly improved. On-site first aid does not have this condition, and doctors can only rely on their own experience and understanding of anatomy to operate.

  From the analysis of the specific anatomical position, the internal jugular vein is next to the outside of the internal carotid artery, so it is written in the textbook that the internal carotid artery must be found first.

   Recalling the steps in the book and teaching video, Xie Wanying carefully raised the child\'s shoulders with clothes first.

  Because it is better to do a high position rather than a low position for intra-cervical puncture, that is, the patient should be padded with the shoulder strap to perform the puncture. This is because during the puncture, if the low puncture fails, it is more likely to have more dire consequences, and it is not easy to detect. The high position is relatively much better, even if most of the punctures are only local skin hematomas.

   Gently tilt the child\'s head back slightly, exposing the child\'s small neck.

   Putting on gloves, gently touched the front and middle of the child\'s neck with fingers, and felt the most obvious bony bump. This is commonly known as the Adam\'s apple, and the anatomical counterpart is the thyroid cartilage.

   From the thyroid cartilage down, the first bony protrusion in the sequence is the cricoid cartilage.

  Swipe your finger across the horizontal line of the cricoid cartilage, and soon you can feel another arterial pulsation point, which is the internal carotid artery.

   After determining the position of the internal carotid artery, simply insert the needle parallel to the outside.

   Fingers determined the position of the internal jugular vein, Xie Wanying raised her head and asked the teacher if she was wrong.

   "That\'s right." Nie Jiamin nodded, and a smile appeared in his silent black eyes. He continued to speak to her in a gentle tone, "You did a good job, you don\'t need to worry."

   At this time, Teacher Nie felt a bit like a kindergarten teacher. Xie Wanying couldn\'t help but feel relieved. Once the nerves are relaxed, the movements become more free.

  Disinfection and laying out sheets.

   The opposite Nie Jiamin helped her to turn the child\'s head to the left and fix it to prevent the child\'s head from moving during the doctor\'s puncture.

  Xie Wanying found and picked up the 22-gauge trocar, connected the syringe, and stared at the patient\'s skin.

   It is enough to judge that the needle is inserted at an angle of more than 30 degrees. The following steps are similar to subclavian venous puncture, which is also a central venous puncture. After puncture, venous blood is withdrawn, a guide wire is placed, the skin is broken, and then fixed.

   Recalling the puncture of the subclavian vein she had done before, Xie Wanying knew very well that as long as the first needle could be accurately inserted into the internal jugular vein, she would not be afraid.

  "Areyouok?" Nie Jiamin looked at her focused face, and there was a slight grim look in her eyes, not sure if she was ready.

   "Yes." Xie Wanying replied, her eyes flashed, and she manually lowered the needle.

   (end of this chapter)