Final- Central Line Principles (7/24/23) Flashcards
Where can central lines (central venous catheter) be placed?
- External Jugular
- Internal Jugular (most common site)
- Subclavian
- Femoral
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
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
The 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?
- 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.
Pt. Positioning for Central Line in the Internal Jugular Vein.
- Trendelenburg to decrease the risk of air embolism and increase venous return
What areas are prepped if performing a central line on the right internal jugular vein?
- Chin
- Sternum
- Shoulder
- Neck
- Ear lobe
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
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)
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.
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