Central Lines
Posted: Tuesday, October 12th, 2021 | Updated: Tuesday, January 10th, 2023
Posted: Tuesday, October 12th, 2021 | Updated: Tuesday, January 10th, 2023
White Port (Proximal Port) |
Blue Port (Medial Port) |
Brown Port (Distal Port) |
Blood administration |
Total parenteral nutrition |
Blood administration |
Medications |
- |
Medications |
Blood Sampling |
- |
Central venous pressure monitoring |
- |
- |
Viscous or high volume fluids |
- |
- |
Colloids |
***Port colors and their ending locations may vary. Always be sure to check the product or original packaging for details
Placement of a Central Line
Typically, the placement of a central line is performed under light sedation and in left lateral recumbency. Occasionally, patients will be too unstable for sedation and will tolerate placement without any drug interventions. The patient is placed in left lateral recumbency ideally so that the right jugular vein is readily accessible. In a perfect world, the left side of the patient's neck is saved for esophageal tube placement if or when needed. Patients with thrombocytopenia, clotting disorders, and/or a traumatic brain injury shouldn't have a central line placed until they are deemed stable enough for one
Next, a rough estimate of the proper length of a central line in cm may be obtained by measuring from mid-neck to just past the thoracic inlet at the third, forth, or fifth rib space. Once the patient has been sedated, placed on proper monitoring equipment, provided flow-by oxygen, and the eyes lubed, open your sterile supplies and have them within reach of you. Two people are generally necessary for this procedure, but having three people is ideal. If you have two people, you will need to open all of your sterile supplies from the start. If you have three people, you will be able to leave the central line pack closed until intravenous access is obtained
First, begin the procedure by clipping the area of interest while making sure the area is free from the patient's hair when you're done. Next, begin scrubbing or cleaning the site of interest with chlorhexidine scrub and either alcohol or sterile 0.9% saline. Afterward, start by assessing and feeling where the vein is. Generally, I like to open my sterile gloves, drape, scalpel, a 22 gauge needle for suturing, a suture packet, appropriately sized IV catheters, clave ports, and sterile gauze right from the start. Once the person restraining is ready, I will glove up in a sterile manner and proceed to drape the patient. I then will place the appropriately sized IVC into the right jugular vein. The third person will help to open the central line pack if this has not already been done. From the central line pack, I will grab and introduce the guidewire through the IVC while monitoring how far I enter and acknowledging the patient vitals on the monitoring equipment. While always having a grasp on the guidewire, I will remove the IVC and introduce the dilator over the guidewire. Sometimes I will advance it in a twisting motion if it does not feed well. If I am unable to insert the dilator through the skin, I will make a small nick in the skin with the scalpel facilitating advancement. Once the vessel is dilated, I will remove the dilator and feed the central line over the guidewire. Making sure to never let go or lose sight of the guidewire, I will advance the central line to the approximate place of a previously measured site making sure to pull the guidewire fully out through the most distal port once there. Next, I will place the clave ports on each line and aspirate them all for blood. Once I know the lines are patent and the air has been removed, I will flush them with a small amount of heparinized saline with a concentration of 1 unit/ml to deter any clot formation. I will then clamp the lines off and suture the central line in place using square knots. This is when the 22g needle may be of assistance. Lastly, I will place a loose wrap of cast padding and Vetrap around the patient's neck to help protect and support the central line. Tegaderm may be used to cover the entrance site
Once vitals, including blood pressure, have been rechecked and the patient is stable, it's good practice to bring the patient to radiology to check the proper placement of the central line. If the catheter is in the heart, it should be backed out some. Ideally, the end of the line will sit just cranial to the right atrium. However, if
Typically, the placement of a central line is performed under light sedation and in left lateral recumbency. Occasionally, patients will be too unstable for sedation and will tolerate placement without any drug interventions. The patient is placed in left lateral recumbency ideally so that the right jugular vein is readily accessible. In a perfect world, the left side of the patient's neck is saved for esophageal tube placement if or when needed. Patients with thrombocytopenia, clotting disorders, and/or a traumatic brain injury shouldn't have a central line placed until they are deemed stable enough for one
Next, a rough estimate of the proper length of a central line in cm may be obtained by measuring from mid-neck to just past the thoracic inlet at the third, forth, or fifth rib space. Once the patient has been sedated, placed on proper monitoring equipment, provided flow-by oxygen, and the eyes lubed, open your sterile supplies and have them within reach of you. Two people are generally necessary for this procedure, but having three people is ideal. If you have two people, you will need to open all of your sterile supplies from the start. If you have three people, you will be able to leave the central line pack closed until intravenous access is obtained
First, begin the procedure by clipping the area of interest while making sure the area is free from the patient's hair when you're done. Next, begin scrubbing or cleaning the site of interest with chlorhexidine scrub and either alcohol or sterile 0.9% saline. Afterward, start by assessing and feeling where the vein is. Generally, I like to open my sterile gloves, drape, scalpel, a 22 gauge needle for suturing, a suture packet, appropriately sized IV catheters, clave ports, and sterile gauze right from the start. Once the person restraining is ready, I will glove up in a sterile manner and proceed to drape the patient. I then will place the appropriately sized IVC into the right jugular vein. The third person will help to open the central line pack if this has not already been done. From the central line pack, I will grab and introduce the guidewire through the IVC while monitoring how far I enter and acknowledging the patient vitals on the monitoring equipment. While always having a grasp on the guidewire, I will remove the IVC and introduce the dilator over the guidewire. Sometimes I will advance it in a twisting motion if it does not feed well. If I am unable to insert the dilator through the skin, I will make a small nick in the skin with the scalpel facilitating advancement. Once the vessel is dilated, I will remove the dilator and feed the central line over the guidewire. Making sure to never let go or lose sight of the guidewire, I will advance the central line to the approximate place of a previously measured site making sure to pull the guidewire fully out through the most distal port once there. Next, I will place the clave ports on each line and aspirate them all for blood. Once I know the lines are patent and the air has been removed, I will flush them with a small amount of heparinized saline with a concentration of 1 unit/ml to deter any clot formation. I will then clamp the lines off and suture the central line in place using square knots. This is when the 22g needle may be of assistance. Lastly, I will place a loose wrap of cast padding and Vetrap around the patient's neck to help protect and support the central line. Tegaderm may be used to cover the entrance site
Once vitals, including blood pressure, have been rechecked and the patient is stable, it's good practice to bring the patient to radiology to check the proper placement of the central line. If the catheter is in the heart, it should be backed out some. Ideally, the end of the line will sit just cranial to the right atrium. However, if
Sources:
On The Job Training and Routine Practices
On The Job Training and Routine Practices