Visitor info Book a COVID-19 test COVID-19 vaccine info

This checklist is to be used for as a for memory recall prior to performing a central line insertion procedure. INSTRUCTIONS - Review all items before and after performing the procedure.

INDICATIONS

No peripheral IV access
Hemodynamic instability
Medications require central line
Other


CONTRAINDICATIONS

Coagulopathy / Thrombocytopenia
Consent not obtained from patient or family


REQUIRED EQUIPMENT

Central line (usually 3 lumen) insertion kit
Cap, mask, sterile gown & gloves
Local anaesthesia (lidocaine 1% or 2% - without epinephrine)


PRE-PROCEDURE TIPS

Select subclavian site if you are comfortable with all sites and if no contraindications
Position patient with head down (Trendelenburg) for subclavian/internal jugular insertions


EVIDENECE-BASED BEST PRACTICES

STERILE PRECAUTIONS:
- Wash hands immediately prior to the procedure
- Put on cap, mask, sterile gown, & sterile gloves
- Sterilize large skin area with chlorhexidine solution
- Drape large area, 4 sides, sterile barrier


DURING THE PROCEDURES

Use local freezing
Do not pass needle more than twice
Call for help if unsuccessful!
Pass the dilator over the guidewire first
Secure the guidewire and pull it out at the end
Advance the line up to 12-15 cm (internal jugular, subclavian) or 20cm (femoral)
Aspirate blood from each lumen and flush it with sterile saline
Suture the line in 2 places (insertion site + hub)


POST-PROCEDURE

Discard sharps
Return patient to regular position
Order chest x-ray, review it and inform nurse of results