E.g. procedure pack with gauze, cotton balls etc.
For jugular and femoral insertion
With sterile ultrasound probe cover and gel
Chlorhexidine
Large drape to cover the entire patient
With needle, guidewire, dilator and CVC
For each lumen of the CVC
For insertion and flushing lines
For local anaesthetic
To flush lumens
1% lignocaine
Suture material, scissors, forceps
Sterile, transparent occlusive dressing
Bin and sharps disposal close by
Supine or Trendelenburg position, raise bed to a comfortable level
Using ultrasound or landmarks
Open all required sterile equipment onto field
Decontaminate a large area with chlorhexidine
Expose the decontaminated site and cover everything else
Draw up local, place everything in the order it will be used
Place bungs on all lumens except central lumen, flush each lumen
Using ultrasound or landmarks
Create a small wheal over the insertion site
Bevel up, 45 degrees from skin until flashback is seen
Non-pulsatile dark blood, ultrasound, manometry, blood gas
Through the needle, soft & flexible end first
While holding onto guidewire, apply pressure to site using gauze
Using the scalpel, make a small incision adjacent to the guidewire
While holding the guidewire, insert dilator just into the vein and then remove it, placing pressure with gauze
Gently insert to appropriate length, while holding onto guidewire
Fix in place at one or two points
Using sterile, transparent occlusive dressing
Internal jugular and subclavian catheters
Using chest x-ray
Right atrium, contralateral subclavian
Especially with jugular and femoral CVCs
Most commonly with subclavian catheters
Not transducing, clot in the line, kinking, pain
Around the CVC
Pain, swelling, erythema, thrombus on USS
Bruising, active bleeding from the site
Erythema, pain, swelling, pus