6030F All elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed (CRIT)

Name of the Procedure:

Inserting a Central Line (Central Venous Catheter Placement)

Summary

This procedure involves placing a long, thin tube called a central line into a large vein, typically in the chest, neck, or groin. It is used to deliver medications, fluids, nutrients, or blood products directly into the bloodstream over a prolonged period.

Purpose

A central line is used to treat several medical conditions and make long-term intravenous therapy easier. It is often used for:

• Administering medications, particularly chemotherapy or antibiotics
• Delivering nutritional supplements (total parenteral nutrition)
• Monitoring central venous pressure
• Drawing blood samples frequently without repeated needle sticks

Indications

• Patients requiring long-term intravenous therapy
• Patients undergoing chemotherapy
• Individuals needing frequent blood draws or transfusions
• Those with poor peripheral veins or requiring central pressure monitoring

Preparation

• Fasting may be required for a few hours before the procedure.
• Adjustments to current medications might be necessary, as advised by the physician.
• Blood tests, such as coagulation profiles, may be done to ensure it's safe to proceed.

Procedure Description

1. Hand hygiene is performed, and maximal sterile barrier techniques are used.
2. The patient is positioned, and the skin over the insertion site is cleaned with an antiseptic solution.
3. If needed, local anesthesia is administered to numb the area.
4. The physician uses ultrasound guidance to locate the target vein (if ultrasound is used, sterile ultrasound techniques are followed).
5. A needle is inserted into the vein, followed by the insertion of a guidewire.
6. The needle is removed, and the central line catheter is threaded over the guidewire and into the vein.
7. The guidewire is removed, and the catheter is secured in place.
8. The insertion site is dressed with a sterile bandage.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is usually performed in a hospital, intensive care unit (ICU), or a specialized outpatient clinic.

Personnel

• Physician or Interventional Radiologist
• Nurses
• Anesthesia provider (if sedation is used)
• Ultrasound technician (if ultrasound guidance is used)

Risks and Complications

• Infection at the insertion site
• Bleeding or bruising
• Accidental puncture of nearby arteries
• Pneumothorax (collapsed lung)
• Thrombosis (blood clots)

Benefits

• Facilitates long-term intravenous therapy
• Reduces the need for repeated needle sticks
• Allows for high-volume or high-concentration medication administration
• Enables accurate central venous pressure monitoring

Recovery

• Patients may need to stay still for a short time after the procedure to ensure the line remains in place.
• The insertion site should be kept clean and dry.
• Regular monitoring and dressing changes are necessary to prevent infection.
• Follow-up appointments are typically needed to check the line's function and address any issues.

Alternatives

• Peripheral IV lines: Less invasive but not suitable for long-term use.
• Peripherally inserted central catheters (PICCs): Another type of long-term IV access, but placement can be more challenging in some patients.
• Subcutaneous ports: Surgically implanted under the skin, suitable for long-term use but requires a minor surgery for placement.

Patient Experience

During the procedure, patients may feel some pressure or discomfort at the insertion site. Pain management options, such as local anesthesia, are provided. Post-procedure, there might be some soreness or bruising at the site, which can be managed with over-the-counter pain medications as advised by the healthcare provider.