Assisting MD insert a central line

Question 1

Have saline available for____

Answer 1

flush (usually, have 3 ten mL syringes ready)

Question 2

do not start fluids until when?

Answer 2

until you have a positive confirmation of placement via chest xray

Question 3

what position are you gonna put the patient in to insert the central line?

if air gets in the line which position do you put the patient in?

Answer 3

• trendellenburg to distend the veins (the patient must look away from the insertion site, and guard the hands because we don’t want them to grab it)
• turn them on their left side because we want the bubble to float from the right atrium and out of the heart. sitting up would cause the bubble to go along with the forward flow of the heart and end up in the lungs.
• you can also do left side trendellenburg.

Question 4

when changing the tubing, how can you avoid getting air in the line?

Answer 4

• manually clamp it off
• have the patient take a deep breath and hold, or hum (causing you to increase intra-thoracic pressure so air can’t go in)
• valsalva manuever (bear down)

Question 5

why is an xray done post-instertion?

Answer 5

• check for placement
• to make sure the doctor did not cause a pneumothorax

Question 6

The proper way to flush a central line:

when giving meds via central line, use the__ technique with the flush. why do we want a syringe to be at least 10cc?

Answer 6

• push/pause
• anything smaller than that will have increase pressure and could damage the catheter.