Confirmation | Central Lines - MedSchool
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Central Lines
Insertion
 

Confirmation

 
 

Confirming Venous Placement

  • Flashback - the flashback from a needle in a vein should be dark red with slow flow. Bright red blood that pulsates indicates arterial catheterisation; the needle should be removed and pressure placed for at least five minutes.
  • Ultrasound - place the sterile probe over the insertion site and examine the vein both parallel and perpendicular to the direction of insertion, looking for presence of the needle / guidewire in the vein (a non-pulsatile, compressible vessel)
  • Manometry - attach the needle to a transducer system to determine intraluminal pressure.
  • Blood gas - send a blood sample for analysis. Compare this with the patient's arterial sample or look at indicators of oxygenation in the result.
Last updated on January 1st, 2018
 
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Baik SY, Kim EK, Hong SK. Strategies to prevent central line-associated bloodstream infections in intensive care units. Journal of Microbiology, Immunology and Infection. 2015 Apr 1;48(2):S75-6.
 Bannon MP, Heller SF, Rivera M. Anatomic considerations for central venous cannulation. Risk Manag Healthc Policy. 2011;4:27-39. Czepizak CA, O’Callaghan JM, Venus B. Evaluation of formulas for optimal positioning of central venous catheters. Chest. 1995 Jun 30;107(6):1662-4.
Graham AS, Ozment C, Tegtmeyer K, Lai S, Braner DA. Central venous catheterization. N Engl J Med. 2007 May 24;356(21):e21.
 Vesely TM. Central venous catheter tip position: a continuing controversy. Journal of Vascular and Interventional Radiology. 2003 May 31;14(5):527-34.
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