E4- Central Line Flashcards
Where can central lines (central venous catheter) be placed?
- External Jugular
- Internal Jugular (most common site)
- Subclavian
- Femoral
Access to the circulation via a large vein
7 Indications for central lines.
- 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
4 Contraindications for central lines.
- Renal cell tumor extending into the right atrium
- Tricuspid valve vegetation
- Site infection
- Site specific
Where do most central lines terminate at?
- Cavoatrial Junction
5 complications of a central line.
- Pneumothorax/Hemothorax
- Line-related infection
- Carotid puncture
- Dysrhythmias
- Trauma to nearby nerves
What are the landmarks for placing a central line in the Internal Jugular Vein?
- Triangle bw SCL muscle + interscalene
- IJ = most common bc less complications that SC + femoral
- Dome of lung above clavicle
Pt. Positioning for Central Line in the Internal Jugular Vein.
- Trendelenburg
- decrease risk of air embolism
- increase venous return
What areas are prepped if performing a central line on the right internal jugular vein?
- Chin
- Sternum
- Shoulder
- Neck
- Ear lobe
If you can’t get your R IJ, now what?
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
Where should the drape cover be if performing a central line?
- Head to foot
- Side to side
What can be used for vein identification if an ultrasound is not available?
- 25 G seeker needle
What is another type of needle used before/after seeker needle?
Catheter over needle
Similar to IV needle
Hook bag up to catheter
* IJ = blood slowly go up back .. carotid = fast back up
Pros and Cons of the Pig Sticker
- 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)
How to tell IJ from Carotid?
IJ = thinner wall, lateral, non-pulsatile, compressible
What kind of motion is used to insert the J-wire?
- Twisting Motion
What should you never do with the J-wire?
- Never let it go of the J-wire when threading it into the patient.
- make sure take cap off to get J-wire out
Catheter Distance
Right IJ:
Right Subclavian:
Left IJ:
Left Subclavian:
- Right IJ: 15 cm
- Right Subclavian: 14 cm
- Left IJ: 18 cm
- Left Subclavian: 17 cm
Placement confirmation of central via ______.
- CXR
- Note catheter tip
- Make sure there is no pneumothorax, hemothorax
- No guidewire left behind
What is used to secure a central line?
- Sutures
- Tegaderm
- Staples
What do you see in the CXR?
- Left hemothorax
- Note the flat angle of the right lung
What do you see in the CXR?
- Left pneumothorax
- The dark side of the chest is filled with air that is outside of the lung tissue.
Where is the Central Line?
- Right IJ
Where is the Central Line?
- Left IJ