Mechanical complications include arterial puncture, hematoma, pneumothorax, hemothorax,arrhythmia, and improper location of the catheter, whether in an accessory vein or in the other vessels of the upper vascular system. Ointments are ineffective, promote antibiotic-resistant bacteria, and increase fungal The rate of catheter-related bloodstream infections. Hubs and antimicrobial-impregnated catheters have been shown to decrease Scheduled changing ofĪ catheter over a guide wire or moving a catheter to a new site can increase mechanicalĪnd infectious complications, and neither is recommended. The rate of catheter-related bloodstream infection. Implementation of these steps has been conclusively shown to decrease Of the necessity of the catheter, with prompt removal when the catheter is no The Institute for Healthcare Improvement recommends five steps to reduce central-line infections: hand hygiene, adherence to maximal barrier precautions, chlorhexidine skin antisepsis, selection of an optimal catheter site, and daily review Infectious ComplicationsĬatheter infections occur by means of one of three mechanisms: Swiss Replica Watches local insertion siteinfection, which travels down the catheter externally or hub colonization followed by infection via the intralumenal route or via hematogenous seeding of the catheter. A chest radiograph should be obtained to confirmplacement and to assess for complications. Risks associated with central venous catheterization include infectious, mechanical, and thrombotic complications. Nonetheless, some general statements can be made and used when obtaining consent from a patient. elective) under which the line is placed. The risk of complications of central line placement varies with the experience of the operator and the conditions (emergency vs. In patients with higher risks for pneumothorax or inability to tolerate pneumothorax, the IJ or femoral sites may also be preferred.The femoral or IJ site is preferred with a coagulopathy or anticoagulation due to the ability to compress the vein in the event of serious hemorrhage. Severe coagulopathy INR > 1.5-1.6 platelets Need for frequent blood draws where peripheral access limited.Hemorrhagic disorder where large volumes blood/blood products needed.Central venous access for infusion of vasoactive drugs, TPN, high dose KCl, etc.Sterile clear dressing (e.g.Internal Jugular Central Venous Line INDICATIONS.3-0 or 4-0 nylon/silk sutures and suture kit (needle holder, scissors, forceps) if not using hand-held needle.Sterile tubing for manometry to confirm venous placement if using.Sterile ultrasound gel and sterile ultrasound probe cover.Cleansing snap-sponge (iodine or alcohol/chlorhexidine) x2.Central venous catheter (7Fr triple-lumen 15cm long catheter most common).Note kits vary and most kits will also have other equipment from the rest of the list included.Cotton gauze swabs x2 (used whenever needed throughout procedure to dry/clean sterile area).2x sterile bowels – one for drawing up saline, one for discarding any blood.2x 10ml syringes for aspirating and flushing.10ml syringe and 3 needles (1 blunt fill 18G drawing-up needle, 1 orange 25G, 1 green 21G) for local anaesthetic.Sterile drape with hole in centre (or 4 drapes without holes in).Gather equipment onto bottom of trolley (think through what you need in order).Wash hands and apply surgical hat and mask.Ensure patient is on cardiac monitor (for internal jugular/subclavian veins).Ensure assistant is available and clinical and non-clinical bins are close by to dispose of waste. **Check patients clotting screen, platelet count and if they have been on an therapeutic anticoagulant/clopidogrel**.Risks: pain, damage to surrounding structures (including pneumothorax, cardiac tamponade/perforation), haemorrhage (including arterial puncture, haematoma, haemothorax), infection, arrhythmias, emboli (including air and guidewire), thrombosis, vessel stenosis.Wash hands, Introduce self, Patients name & DOB & wrist band, Explain procedure and get written consent if possible.Indications: intravenous access, central venous pressure monitoring, infusion of irritant medications, renal replacement therapy, transvenous pacing, central venous oxygen saturation monitoringĬontraindications: obstructed vein, overlying infection, haemorrhage from target vesselĬontraindications to internal jugular/subclavian: coagulopathy (INR >1.4, platelets <50, therapeutic anticoagulant <24 hours, clopidogrel <7days), respiratory failure, raised intracranial pressure Introduction Veins: internal jugular, subclavian (highest bleeding and pneumothorax risk), femoral (highest infection risk)
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