Central Line Placement:Procedure guide

Indications:

Venous access is needed for intravenous fluids or antibiotics and a peripheral site is unavailable or not suitable
Central venous pressure measurement
Administration of certain chemotherapeutic drugs or total parenteral nutrition (TPN)For hemodialysis or plasmapheresis

Contraindications:

Uncooperative patient
Uncorrected bleeding diathesis
Skin infection over the puncture site
Distortion of anatomic landmarks from any reason
Pneumothorax or hemothorax on the contralateral side

Relative contraindications:

Positive end-expiratory pressure (PEEP) mechanical ventilation
Only one functioning lung
Procedure Step-by-Step
Explain the procedure to the patient and obtain a written informed consent, if possible.
Explain the risks, benefits and alternatives (RBA).
Get to know the equipment in the standard central line placement kit.

Do not forget to put the needles in the sharp objects collector box. Order a CXR to rule out a pneumothorax and write a procedure note.

Complications:
Pneumothroax
Hemothorax
Arrhythmias
Air embolism
Introduction of infection

Write a procedure note which documents the following:

Patient consent
Indications for the procedure
Relevant labs, e.g INR/PTT, platelet count
Procedure technique, sterile prep, anesthetic, amount of fluid obtained, character of fluid, estimated blood loss
Any complicationsTests ordered




Click here to see slide show of the procedure
Slideshow details:
Authors: V. Dimov, M.D., The Cleveland Clinic, B. Altaqi, M.D.,
Trover Foundation Health Care
Photos: 48
Jun 20, 2006
Size: 4 MB

Other links for central line placement:
Video show central venous catheterization
Internal Jugular Vein Cannulation - The UCSF Hospitalist Handbook
Central Venous Access. eMedicine, July 29, 2005.
Central Venous Line Placement:University at Buffalo.
Central Line Placement Algorithm :madigan army medical center
Emergency procedures:central line placement on youtube
part1 /part2/ part3 /part4 / part5