Assisting with Percutaneous Central Venous Catheter Placement

Assisting with Percutaneous Central Venous Catheter Placement

Equipment
■ Sterile gloves (2 or 3 pairs).
■ Masks, hats, barrier gowns.
■ 10-mL vials of normal saline (3 or 4), 2 or 3 syringes with 1-in. needle.
■ 25-gauge 5/8-in., and 18-gauge 11/2-in. needles (2 or 3 of each).
■ CVC kit containing: an introducer, antiseptic solution/swabs, sterile drapes, 10-mL syringe, 1% or 2% Xylocaine without epinephrine, suture, sterile scissors, and needle holder.
■ CVC (single-lumen or multilumen).
■ Injection caps.
■ Alcohol wipes.

Assessment
■ Obtain baseline VS.
■ Verify that informed consent has been given.
■ Assess for allergy to tape.

Post-Procedure Reassessment
■ Be Safe! Obtain VS.
■ Ausculate the lungs and assess for respiratory distress, sharp chest pain, and coughing.
■ Monitor for 24 hours for these signs.
■ Assess the patient daily to determine continuing need for the CVC.

Key Points
■ Be Safe! Perform meticulous hand hygiene.
■ Be Safe! Use gowns and maximum barrier precautions.
■ Be Safe! Use meticulous sterile technique.
■ Obtain VS and verify informed consent.
■ Gather and set up supplies and equipment.
■ Prepare sterile field, and add supplies.
■ Position the patient (Trendelenburg with a rolled towel between the shoulders).
■ Offer mask, gown, and sterile gloves to physician.
■ Don sterile gloves and mask (or follow agency policy).
■ Prep an 8 10-in. area around the site, using applicators of 2% CHG in 70% alcohol, per agency guidelines.
■ Place the large sterile drape to cover patient’s head and chest.
■ Have the patient turn his head opposite the direction of insertion.
■ Observe while the physician inserts and sutures the catheter.
■ Apply sterile transparent dressing, close any lumen clamps, and place tape across the lumens near the injection caps.
■ Monitor for complications (especially respiratory distress).
■ Be Safe! Obtain a chest x-ray to confirm correct placement of the catheter tip.

Documentation
■ Document date and time of catheter insertion, catheter type and size, and site location.
■ Chart:
■ Assessments and interventions performed at insertion and immediately after.
■ Patient’s tolerance of procedure (subjective and objective data).
■ X-ray verification of catheter placement.