E4- Central Line

Question 1

Where can central lines (central venous catheter) be placed?

Answer 1

• External Jugular
• Internal Jugular (most common site)
• Subclavian
• Femoral

Access to the circulation via a large vein

Question 2

7 Indications for central lines.

Answer 2

• Monitoring central venous pressure
• Infusion of caustic drugs
• Administration of TPN
• Aspiration of air emboli (wishful thinking)
• Insertion of transcutaneous pacing leads
• Venous access for people w/ poor peripheral veins
• Dialysis access

Question 3

4 Contraindications for central lines.

Answer 3

• Renal cell tumor extending into the right atrium
• Tricuspid valve vegetation
• Site infection
• Site specific

Question 4

Where do most central lines terminate at?

Answer 4

• Cavoatrial Junction

Question 5

5 complications of a central line.

Answer 5

• Pneumothorax/Hemothorax
• Line-related infection
• Carotid puncture
• Dysrhythmias
• Trauma to nearby nerves

Question 6

What are the landmarks for placing a central line in the Internal Jugular Vein?

Answer 6

• Triangle bw SCL muscle + interscalene
• IJ = most common bc less complications that SC + femoral
• Dome of lung above clavicle

Question 7

Pt. Positioning for Central Line in the Internal Jugular Vein.

Answer 7

• Trendelenburg
• decrease risk of air embolism
• increase venous return

Question 8

What areas are prepped if performing a central line on the right internal jugular vein?

Answer 8

• Chin
• Sternum
• Shoulder
• Neck
• Ear lobe

Question 9

If you can’t get your R IJ, now what?

Answer 9

o Cant get IJ on Right – go for subclavian on RIGHT

 Subclavian not common bc chances of ptx
 Go from R IJ + hit carotid + cause hematoma – then go to L IJ
* Circumferential edema around airway
o KANE preps both sides to save time

Question 10

Where should the drape cover be if performing a central line?

Answer 10

• Head to foot
• Side to side

Question 11

What can be used for vein identification if an ultrasound is not available?

Answer 11

• 25 G seeker needle

Question 12

What is another type of needle used before/after seeker needle?

Answer 12

Catheter over needle
 Similar to IV needle
 Hook bag up to catheter
* IJ = blood slowly go up back .. carotid = fast back up

Question 13

Pros and Cons of the Pig Sticker

Answer 13

• 14 ga needle
• No catheter; guidewire threaded from the back end of the needle.
• Pro: minimized movement; all parts stay together
• Con: No visualization of blood (artery vs. vein)

Question 14

How to tell IJ from Carotid?

Answer 14

IJ = thinner wall, lateral, non-pulsatile, compressible

Question 15

What kind of motion is used to insert the J-wire?

Answer 15

• Twisting Motion

Question 16

What should you never do with the J-wire?

Answer 16

• Never let it go of the J-wire when threading it into the patient.
• make sure take cap off to get J-wire out

Question 17

Catheter Distance
Right IJ:
Right Subclavian:
Left IJ:
Left Subclavian:

Answer 17

• Right IJ: 15 cm
• Right Subclavian: 14 cm
• Left IJ: 18 cm
• Left Subclavian: 17 cm

Question 18

Placement confirmation of central via ______.

Answer 18

• CXR
• Note catheter tip
• Make sure there is no pneumothorax, hemothorax
• No guidewire left behind

Question 19

What is used to secure a central line?

Answer 19

• Sutures
• Tegaderm
• Staples

Question 20

What do you see in the CXR?

Answer 20

• Left hemothorax
• Note the flat angle of the right lung

Question 21

What do you see in the CXR?

Answer 21

• Left pneumothorax
• The dark side of the chest is filled with air that is outside of the lung tissue.

Question 22

Where is the Central Line?

Answer 22

• Right IJ

Question 23

Where is the Central Line?

Answer 23

• Left IJ