Final- Central Line Principles [7/16/24] Flashcards
Central line is also known as?
They are used to access the circulation via a ____.
- Central Venous Catheter
- Large vein
S2
Where can central lines (central venous catheter) be placed?
- External Jugular
- Internal Jugular (most common site)
- Subclavian
- Femoral
S2
Indications for central lines.
- Infusion of caustic drugs
- Monitoring CVP
- Insertion of transvenous pacing leads
- Venous access for people w/ poor peripheral veins
- Administration of TPN
- Aspiration of air emboli
- Dialysis access
CVL Indications May Include Venous Access All Day
S3
Contraindications for central lines.
- Renal cell tumor (thrombi) extending into the right atrium
- Tricuspid valve vegetation
- Site infection
- Site specific- no femoral line for ambulatory pts
S4
The complications of a central line.
- Trauma to nearby nerves
- Carotid puncture
- Line-related infection
- Pneumothorax/Hemothorax
- Dysrhythmias (Vtach-pull wire back)
Take Central Line Problems Down
S5
The set up for placing a central line includes what 2 things?
- check list
- time out
S6
Where do we usually start central lines?
IJ- lower complications
S7
What are the landmarks for placing a central line in the Internal Jugular Vein?
- The needle should be inserted at the triangle’s apex formed by the sternocleidomastoid muscles: sternal head and clavicular head.
- From the apex, aim at the ipsilateral nipple (same side), and insert the needle 45 degrees into the skin.
S7
Where do most central lines terminate at?
- Cavoatrial Junction
ANDY
Pt. Positioning for Central Line in the Internal Jugular Vein.
- Trendelenburg
- to decrease the risk of air embolism
- increase venous return
S8
Where should the US machine be placed?
Across from the provider?
have everything on the same sides. Create a stable enviroment so you have micromovements.
S8-lecture
What areas are prepped if performing a central line on the right internal jugular vein?
- Chin
- Sternum
- Shoulder
- Neck
- Ear lobe
Prep your SSCEN
S9
Prep way more than you need incase you need to stick more than once. Kane would prep all the way over both sides and down to the nipple
Where should the drape cover be if performing a central line?
- Head to foot
- Side to side
S10
When gaining access we need to consider what 2 things?
in-plane vs out of plane
S11
What can be used for vein identification if an ultrasound is not available?
- 25 G “seeker needle”
used to make tiny little holes in the neck. If you stick the carotid with small needle, it self seals. This is a safety mechanism.
S12
Another way for vein identification instead of using a seeker needle
Catheter over needle
S13
A 3rd method of vein identification
- Echogenic 18g needle attached to a raulerson syringe [kane calls it the pig sticker]
- place the guidewire through the needle, then pull needle and syringe all the way off
- If you dont disconnect the syrgine, you can’t get a visual of whether you are in a vein or artery
S14
Pros and Cons of the Pig Sticker
- 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)
S14
How do we differentiate between the carotid and IJ
The IJ is more lateral, thinner walled, and non-pulsatile
S15-lecture
- Where/how do you insert the J wire?
- What kind of motion is used to insert the J-wire?
- insert J wire through needle or catheter.
- remove needle
- nick skin to enlarge opening
- advance the catheter over the wire
- Twisting Motion
S16 and 17-lecture
What should you never do with the J-wire?
- Never let it go of the J-wire when threading the catheter into the patient.
S17
Remember to remove what 2 things after placing the central line
J wire and cap catheter
taking the cap off so you can thread the catheter back out.
S18
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
S19
Placement confirmation of central via ______.
- CXR
- Note catheter tip
- Make sure there is no pneumothorax, hemothorax
- No guidewire left behind
S20
What is used to secure a central line?
- Sutures
- Tegaderm
- Staples
S21
Where is the Central Line?
- Right IJ
S22
Where is the Central Line?
- Left IJ
S23
What do you see in the CXR?
- Right pneumothorax
- The dark side of the chest is filled with air that is outside of the lung tissue.
S24
What do you see in the CXR?
- Left hemothorax (looks white)
- Note the flat angle of the right lung–> acute costophrenic margin
S25
Loss of guidewire studies have shown an estimated loss of 1:____
or 1: ____ according to a couple of case studies…
1:1611 or 1:3291
S26
