Procedures » CVC Internal Jugular Central Line

DOCUMENTATION

EQUIPMENT

  • Bundle Pack
  • Triple Lumen Catheter (TLC)
  • Sterile Gloves
  • 3 sterile line caps
  • Sterile Ultrasound Cover
  • Ultrasound Machine

PROCEDURE

  • Sterilize the patient and apply mask, cap, sterile gown and gloves
  • Cover the patient and apply sterile probe cover
  • Flush TLC, leave brown cap uncovered, replace caps with sterile line caps
  • Prepare guidewire
  • Visualize the vein with ultrasound
  • Anesthetize the area with the lidocaine
  • Visualize the needle entering the vein using ultrasound, once non-pulsatile blood is aspirated remove syringe
  • Insert guidewire, and NEVER let your hand off the wire from this point on
  • Once guidewire is inserted remove needle, use scalpel to nick the skin at insertion site
  • Insert dilator over the wire and hold at the skin and twist in one direction while inserting
  • Remove dilator and hold pressure with gauze
  • Insert TLC over the wire, once the wire can be grabbed from the other side, slide catheter over wire
  • REMOVE WIRE
  • TLC is placed at 15cm on the right and 18cm on the left
  • Aspirate blood first and flush all three lines with sterile saline and confirm good return
  • Place Biopatch blue side up, suture the line in place, 4 sutures needed, place sterile tegaderm
  • Discard sharps
  • Chest x-ray for placement and rule out pneumothorax

PROCEDURE NOTE

Date:

Indication: Hemodynamic Monitoring/Intravenous access

Resident:

Attending:

Consent was obtained and a time-out was completed verifying correct patient, procedure, site, and positioning. The patient was placed in appropriate dependent position for central line placement. The patient’s right(?)left groin was prepped and draped in sterile fashion. 1% Lidocaine was(?)was not used to anesthetize the surrounding skin area. Ultrasound was(?)was not used to identify the vein and observe the needle entering the vein. A triple lumen catheter was introduced into the internal jugular vein using Seldinger technique. The catheter was threaded smoothly over the guide wire and guide wire was removed. Appropriate blood return was obtained and each lumen of the catheter was evacuated of air and flushed with sterile saline. The catheter was then sutured in place to the skin and a sterile dressing applied. The patient tolerated the procedure well and there were no complications. Blood loss was minimal.