Indications
Vasopressors, TPN, certain chemotherapy, haemodynamic monitoring, frequent bloods
Contraindications
Coagulopathy, localised deformity
Equipment & Preparation
Insertion
Explain the procedure and ask for patient's consent
Positioning
Place patient on monitoring including ECG
Identify the Vein
Using ultrasound or landmarks
Prepare Sterile Field
Open all required sterile equipment onto field
Don cap and mask
Scrub then don sterile gown and gloves
Prepare the Site
Decontaminate a large area with chlorhexidine
Place the Drape
Expose the decontaminated site and cover everything else
Prepare Equipment
Draw up local, place everything in the order it will be used
Prepare the PICC Line
Place bungs on all lumens except central lumen, flush each lumen
Place sterile probe cover onto ultrasound probe with gel
Reidentify the Vein
Using ultrasound or landmarks
Inject Local Anaesthetic
Create a small wheal over the insertion site
Insert the Needle
Bevel up, 45 degrees from skin until flashback is seen
If the needle or catheter must be removed at any time, place pressure on the insertion site in order to prevent haematoma formation.
Confirm Venous Placement
Non-pulsatile dark blood, ultrasound, manometry, blood gas
Advance the Guide Wire
Through the needle, soft & flexible end first
Remove the Needle
While holding onto guidewire, apply pressure to site using gauze
Make an Incision
Using the scalpel, make a small incision adjacent to the guidewire
Use the Dilator
While holding the guidewire, insert dilator just into the vein and then remove it, placing pressure with gauze
Introduce the Catheter
Gently insert to appropriate length, while holding onto guidewire
Remove the Guidewire
Aspirate then flush each lumen with saline
Suture the Catheter
Fix in place at one or two points
Dress the Site
Using sterile, transparent occlusive dressing
Document
Confirm the CVC Position
Internal jugular and subclavian catheters
Using chest x-ray
Complications
Malposition
Right atrium, contralateral subclavian
Arterial Puncture
Especially with jugular and femoral CVCs
Pneumothorax / Haemothorax
Most commonly with subclavian catheters
Air Embolism
Blockage
Not transducing, clot in the line, kinking, pain
Thrombosis
Around the CVC
Pain, swelling, erythema, thrombus on USS
Haemorrhage / Haematoma
Bruising, active bleeding from the site
Infection
Erythema, pain, swelling, pus