Chapter 894: You did great Chapter 894: You did great Teacher Nie’s tone was always like a calm pond, perfectly encapsulating the exceptional composure of a pediatric surgeon.

Unlike Teacher Tan and Senior Tao, who would encourage her more as she grew more timid, Teacher Nie showed a different kind of boss-like style in this regard. The slight irritation in Xie Wanying’s heart seemed to be smoothed over by Teacher Nie’s calm gaze. She steadied her mind and got ready.

There was only a character difference between the internal jugular vein and the external jugular vein, yet they were vastly different. One was a superficial vein, the other a deep vein. As a deep vein, the internal jugular vein ran deep among the muscles, making it much harder to locate than the superficial veins visible to the naked eye in the superficial fascial layer. The difficulty in locating it meant that the puncture’s difficulty was exponentially higher.

Such deep vein punctures could only be performed by a doctor.

It would be best if it was guided by ultrasound, as the success rate of puncturing an unseen vein could be significantly increased. In an emergency scenario onsite, doctors could only rely on their own anatomical knowledge and understanding.

Analyzing from the specific anatomical location, the internal jugular vein is next to the external side of the carotid artery, so textbooks say that one must first locate the internal carotid artery.

Recalling the steps from books and instructional videos, Xie Wanying carefully used clothes to prop up the child’s shoulders.

Because it is better to perform an internal puncture in a high position rather than a low, i.e., elevating the child’s shoulder to perform the puncture. This is because a low-position puncture could more easily result in more severe consequences like pneumothorax, which is also harder to detect. A high position is much better; even if punctured, it mostly results in local skin hematomas.

She gently tilted the little one’s head back a little, exposing the child’s small neck.

She put on her gloves, her fingers gently touching the center of the child’s neck, feeling for the most prominent bony protrusion. This was commonly known as the Adam’s apple, anatomically corresponding to the thyroid cartilage.

Moving down from the thyroid cartilage, the first bony protrusion she felt in order was the cricoid cartilage.

Her fingers crossed the horizontal line of the cricoid cartilage and soon she could feel another pulsating point, the internal carotid artery.

Having determined the location of the internal carotid artery, all that was left was to advance the needle parallel to its outer side.

With her fingers having determined the location of the internal jugular vein, Xie Wanying looked up and sought confirmation from her teacher with her eyes to see if her positioning was correct.

“It’s correct,” Nie Jiamin nodded with a subtle smile emerging in his tranquil black eyes, his refined tone continuing to reassure her, “You’re doing great, don’t worry.”

In that moment, Teacher Nie seemed a bit like a kindergarten teacher to her. Xie Wanying couldn’t help but feel a bit more relaxed. Her nerves eased, and her movements became more fluid.

Disinfect, lay out the sterile drape.

Nie Jiamin, opposite her, helped to tilt and stabilize the child’s head to the left side to prevent movement during the doctor’s puncture.

Xie Wanying found and picked up a 22-gauge catheter needle, connected the syringe, and focused on the patient’s skin.

She determined that inserting the needle at slightly more than a 30-degree angle was sufficient. The following steps were similar to the subclavian vein puncture, another central venous puncture, withdrawing venous blood after the puncture, inserting the guidewire, making an incision, and then securing it.

Recalling the subclavian vein punctures she had performed before, Xie Wanying was clear, as long as the first needle accurately entered the internal jugular vein, there was nothing to fear.

“Are you ok?” Nie Jiamin scrutinized her focused face, with a slightly stern expression emerging in his eyes, unsure whether she was truly ready.

“Yes,” Xie Wanying replied, her eyes flashed, her hand moved, needle down.