Central Line Insertion Flashcards

1
Q

Indication for central line insertion

A
  • Hemodynamic monitoring (Central venous pressure)
  • Insertion of PA catheter
  • Rapid fluid resuscitation or rapid blood
    replacement therapy
  • Infusion of vasoactive substances, chemotherapy or hyperalimentation
  • Transvenous pacing
  • Aspiration of air embolism
  • Temporary dialysis access
  • Plasmapheresis
  • Poor peripheral venous access
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2
Q

Absolute contraindications to central line insertion

A
  • Patient refusal
  • Infection at insertion site
  • Anatomic obstruction (thrombosis, anatomic variance, carotid disease)
  • Superior vena cava syndrome
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3
Q

Relative contraindications to central line insertion

A
  • Coagulopathy
  • Systemic infection
  • RVAD
  • Presence of pacing wires or other indwelling catheters at insertion site
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4
Q

Patient position (s) for central line insertion

A
  • Supine

- Trendelenberg with head turned 45 degrees away from insertion site

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5
Q

During insertion prep, use chlorhexidine gluconate sterile prep for at least ____

A

30 seconds (then allow it to dry for 2 mins)

For kids, use iodine instead

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6
Q

Most common insertion site of central line for cardiac anesthesia

A

IJ vein

lower incidence of pneumothorax compared to SC vein cannulation

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7
Q

Where is the IJ located?

A

between the sternal and clavicular heads of the sternocleidomastoid muscle

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8
Q

Why is the right IJ preferred over the left IJ for central line insertion?

A
  • Takes a straight course to RA, easier to portion at SVC-RA junction
  • Has lower incidence of pneumothorax compared to the left (o/t lower dome of pleura on right side)
  • Avoids thoracic duct injury
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9
Q

What is drawback to the IJ site for central line insertion?

A

More likely to become contaminated due to respiratory secretions

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10
Q

Rank the anatomical site in order of most likely to get infected for central lines

A
#1 Femoral (15.3%)
#2 IJ (8.6%)
#3 SC (4%)
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11
Q

Rank the anatomical site in order of most likely for arterial puncture for central lines

A
#1 Femoral (6.25%)
#2 IJ (3%)
#3 SC (0.5%)
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12
Q

Complications of central lines

A
  • Hematoma
  • Arterial puncture
  • Infection
  • Arrhythmia
  • Cardiac perforation and tamponade
  • Thoracic duct injury
  • Pneumothorax (0.1-0.2% for IJ, 1.5-3.1% for subclavian)
  • Hemothorax (with subclavian)
  • Nerve injury
  • Venous thrombosis, pulmonary emboli
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13
Q

For right IJ, the catheter should be secured at around ____ depending on patients

A

16 cm

Formula for Rt IJ:
Height/10cm

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14
Q

For right subclavian, the catheter should be secured at around ____ depending on patient’s height

A

15 cm

Formula for Rt SC:
(Height/10) - 2cm

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15
Q

For left IJ, the catheter should be secured at around ____depending on the patient

A

20 cm

Formula for Left IJ:(height/10) + 4 cm

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16
Q

For left subclavian, the catheter should be secured at around ____ depending on the patient

A

19 cm

Formula for Left SC:(height/10) + 2 cm

17
Q

Steps for central line removal

A
  • Place the patient in Trendelenberg position
  • Ask the patient to exhale as the catheter is removed to prevent air embolism
  • Apply pressure over the site for 1-2 minutes until hemostasis is achieved
18
Q

Review slides 10-13 for insertion procedure

A

…..

19
Q

How should the IJ appear on ultrasound?

A
  • Superficial
  • Larger
  • Oval-shaped
  • Compressible
20
Q

If not using ultrasound, how would locate the IJ?

A
  • Connect finder needle to syringe
  • Start at the apex of the triangle, advancing towards the ipsilateral nipple at a 30-45 degree angle to the skin while continuously aspirating until blood flows freely into the syringe
21
Q

How far should you advance guidewire? What is a concern with guidewire insertion?

A
  • 6-8cm
  • Watch for PVC’s, dysrhythmias
  • If they occur, withdraw guidewire immediately