ultrasound central line. most providers no longer use landmarks for central line placement except...
DESCRIPTION
Most providers no longer use landmarks for central line placement except for with subclavian lines and occasionally femoral lines Increased accuracy Increased efficiency Ability to confirm placement in real timeTRANSCRIPT
HOW TO….Ultrasound Central Line
EQUIPMENT
STANDARD OF CARE Most providers no longer use
landmarks for central line placement except for with subclavian lines and occasionally femoral lines
Increased accuracy Increased efficiency Ability to confirm placement in real
time
WHY USE ULTRASOUND…
ANATOMY
POSITIONING Trendelenburg positioning Phythagorean theorem
PRIOR TO THE PROCEDURE Order in EPIC the “ultrasound ED
bedside” prior to the procedure. At the ultrasound machine click the new
patient button and click on the worklist at the bottom of the screen.
Select the pt from the list. Enter your name under operator and press exit.
Now you will be able to save images for your central line.
WHAT YOU’LL NEED The Site Rite or the Zonare US machines Sterile US probe Cover Sterile Gloves Betadine/Chlorhexidine Sterile saline/ Blue caps Central Line Kit
Should have everything else you need A nurse/tech ready to help if you need
anything else
SELDINGER TECHNIQUE Still use the Seldinger technique
Needle Wire remove needle Small incision at skin dilator back thread the wire through the triple lumen Remove wire suture in place
Never let go of the wire
Difference is you can use the US to see the vein and vein puncture
http://www.youtube.com/watch?v=cYzVPMQc3aY&feature=related
DOCUMENTATION Please type .procdoc under the procedure
section of your note. Click on the blue hyperlink for your ultrasound order.
You do not have to fill out the information, just write “see note” in the comments section.
Then go to your note and use the .EDUS smartphrases to document your findings. Using the central line documentation under procdoc will work. Self made ones may not if they do not include the line “Wire seen in vein and images saved to patients permanent record.”
CONFIRM
CONFIRM
PEARLS/PITFALLS Failure to identify the needle in the tissue.
Failure to distinguish between vein and artery.
Angling the transducer towards the entry site of the needle on the skin may help visualize the needle earlier.
Avoid advancing the catheter if the needle tip is not visualized.
Trendelenburg position, Valsalva Maneuver,
Use caution when utilizing a long axis approach to central venous cannulation due to the inability to maintain visualization of the carotid artery at all times.
Sterile US gel
Failure to document with .procdoc and .edus smartphrases