Page 40 - Radiology Book

central venous line Placement continued
· Watch for ash of blood.
· While stabilizing needle with thumb and fore nger,
remove the syringe. Ensure that the blood exiting the needle is NON-PULSATILE and DARK. If in doubt, withdraw the needle and apply pressure.
· Thread the J-wire through the needle, aiming the curve toward the heart until you reach the 30-cm mark. Watch for ectopy.
· Secure the J-wire while sliding the needle off and make a small stab along the guide wire.
· Thread the plastic dilator over the wire and advance the dilator fully into the chest.
· Remove the dilator and leave the J-wire.
· Thread the catheter over the wire into the vein to a
depth of 12–18 cm depending on patient size and entry
site. Remember, never let go of the J-wire.
· Carefully remove the J-wire and place the blue port.
· Aspirate all ports to ensure blood return, then ush each.
· Secure catheter in at least 3 places using sutures.
· Place a BIOPATCH and a sterile occlusive dressing
(Tegaderm) over the catheter.
6. Obtain a STAT post-procedure chest x-ray.
· Is there a PTX or hemothorax?
· Is the catheter properly positioned?
central line dePtH
Vessel
Right
Left
IJ
12 cm
14 cm
Subclavian
12–14 cm
14–16 cm
Femoral
No limit
Paracentesis
Prep Work
Supplies
· Paracentesis or thoracentesis kit with adapter, thoracentesis set for vacuum bottles.
· Sterile and nonsterile gloves.
· Betadine or chlorhexidine for skin prep.
· 5x5 gauze, 2 drapes/towels (Chux).
· Vacuum bottles (large volume > 6 L consider albumin).
· Do not aspirate >5L for patients who have a Child’s Pugh class C score
Southfield16
Procedures