Page 39 - Radiology Book

central venous line Placement
Before starting, choose placement and gather materials
· Always use the right IJ if possible; it is the most direct
path and has the lowest likelihood of complications. If the patient has severe unilateral lung disease (PTX, HTX, PNA), choose the affected side to avoid dropping the only good lung. Always obtain CONSENT.
· Always use ultrasound for IJ placements in nonemergent situations. Reduce the chance of an arterial stick and PTX; check for clots in the IJ before beginning. The intended target is compressible.
· Ensure no infection over the planned insertion site.
· Check INR and PLTs. If INR >1.5 or PLTs <50, a femoral
approach is favored.
Central Line Placement Procedure
1. Gather supplies: drape tray, central line tray, sterile gloves, mask and shield, BIOPATCH, site rite, probe cover, ushes
2. Placetheblueportsovertheauxiliaryports.Leavethe brown port open. Flush the ports with saline.
· Place the patient in a Trendelenberg position to reduce
the risk of air emboli. Turn the patient’s head to the contralateral side. Place a rolled towel or sheet between the shoulder blades (for subclavian lines). Restrain patient or administer light sedation if needed.
· Prep and drape the area. Use universal precautions/ sterile technique.
3. Use ultrasound to locate landmarks.
· Subclavian:
Clavipectoral groove. Mark entry 2 cm inferior and 1 cm medial to the clavipectoral groove. Aim needle at the sternal notch.
· Internal jugular: Use ultrasound to identify compressible vein over distal third of neck. Landmarks are division of the SCM and 1 cm lateral to the palpated carotid.
· Femoral: Nerve/artery/vein from lateral to medial below the inguinal ligament.
4. Anesthetize with lidocaine (deeper for subclavians).
5. Insert an 18-gauge needle on a syringe, aspirating while slowly advancing the needle.
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Procedures