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Subject: Central Venous Catheter Placement
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One multilumen indwelling catheter: size varies depending on location and reason
One spring-wire guide: straight soft tip on one end with a J-tip on the other end
One fastener: catheter clamp
One introducer needle: 18-gauge with a 12-mL syringe
One injection needle: 22-gauge with a 5-mL syringe
One injection needle: 25-guage with a 3-mL syringe
Skin prep materials (see Appendix E)
One 5-mL ampule of HCL, 1% lidocaine solution
One tissue dilator
One drape: 24 × 36 inches with 4-inch fenestration
Two gauze pads: 2 × 2 inches
Five gauze pads: 4 × 4 inches
One no. 11 scalpel
One suture: 3-0 silk with cutting needle
To allow administration of numerous medications simultaneously, such as total parenteral nutrition, chemotherapy, and pressor agents
To administer drugs that have a higher risk of causing phlebitis when given through a peripheral intravenous catheter
To establish access to the central circulation if a pulmonary artery catheter or pacemaker placement is necessary
To gain access to central circulation if peripheral veins cannot be cannulated
To gain access for hemodynamic monitoring, such as to facilitate measurement of central venous pressure and venous oxyhemoglobin saturation
To facilitate plasmapheresis, apheresis, hemodialysis, or continuous renal replacement therapy
Injury distal to the vessel to be cannulated
Wounds directly over the cannulation site
Infection or overlying cellulitis in area around vessel to be cannulated
If the vessel to be cannulated has a known thrombus
Pearl: Place the patient in a Trendelenburg position of at least 15 degrees down to distend the neck veins and reduce the risk of an air embolism.
Pearl: The subclavian artery usually lies deeper than the vein; to reduce risk of subclavian artery puncture, avoid deep penetration by the probe needle.
Pearl: To lessen risk of air embolism, occlude the needle with a finger.
Pearl: For extra security, tape the intravenous tubing in place.
PITFALL: Obtain a chest x-ray to identify the position and placement of the intravenous catheter and a possible pneumothorax.
PEARL: To lessen risk of air embolism, occlude the needle with a finger.
PITFALL: Obtain chest and abdominal x-rays to identify the position and placement of the intravenous catheter.
PITFALL: Remember that the catheter should be changed as soon as practical to reduce complications of infection and thrombosis.
Pneumothorax or hemothorax
Arterial or neurologic injury
Deep venous thrombosis
Arterial and neurologic injury
American Hospital Supply. Phone: 407-475-1168. Web site: http://www.americanhospitalsupply.com/.
Arrow Medical Products Ltd., 2400 Bernville Road, Reading, PA 19605. Phone: 800-233-3187. Web site: http://www.arrowintl.com/.
Baxter, 1 Baxter Pkwy., Deerfield, IL, 60015-4625. Phone: 847-948-2000. Fax: 847-948-3642. Web site: http://www.baxter.com.
Cardinal Health, Inc., 7000 Cardinal Place, Dublin, OH 43017. Phone: 800-234-8701. Web site: http://www.cardinal.com/.
Owens and Minor, 4800 Cox Road, Glen Allen, VA 23060-6292. Phone: 804-747-9794. Fax: 804-270-7281.