How to Place Central Venous Catheters
According to the National Cancer Institute, a central venous catheter (CVC) is a tube placed into a large blood vessel like your subclavian vein in your neck or your femoral vein in your groin. This tube has an important job description: It administers life-saving medications and vital fluids to an extremely sick patient. Emergency room physicians are proficient in inserting a CVC in times of medical crisis and nurses care for the CVC post-placement to prevent a dangerous bacterial infection. A professional must follow specific steps on how to place central venous catheters.
Things You'll Need
- Sterile gloves
- Sterile
- Sterile towel
- Mask
- Permanent marker
- IV tubing
- IV fluid
- Central line kit
- Silastic dilator
- Bath towel
- Betadine solution
- Sterile gauze
- 22-gauge needle
- 25-gauge needle
- 18-gauge needle
- Small bottle of lidocaine
- Scalpel
- Suture material
- Clear dressing
Instructions
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1
Place your mask tightly across your face and tie the strings toward the back of your head.
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2
Open the sterile gown package and be careful not to touch the gown as this can contaminate it.
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3
Drop the gown onto a sterile surface while holding the outside of the package.
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4
Open the package of gloves by peeling back on the packet and drop the gloves onto the sterile surface.
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5
Go to the patient and use a permanent marker to mark a spot 1 cm below the clavicle (collarbone) and in between the middle and end of the clavicle.
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6
Wash your hands thoroughly with soap and water and use a sterile towel to dry them well.
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7
Put on your gown and gloves with the help of a medical assistant.
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8
Lower the head of the bed 15 to 30 degrees so the patient's head is lower than his feet. This is the Trendelenburg position. This is a position that prevents air from going into the patient's lungs.
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9
Turn the patient's head opposite to the side chosen. For example, if you marked a spot on the right clavicle, turn the patient's head to the left.
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10
Roll the towel and place it underneath the patient's shoulder blade. This will better reveal the clavicle. Check that the towel is on the same side as the mark you made.
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11
Place the patient's arms to his side.
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12
Locate the great vessels in the neck. Look for the subclavian vein and artery.
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13
Have your medical assistant open the betadine solution.
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14
Place the sterile gauze in the solution and rub the solution on the marked site making a small circle and gradually making larger circles outward towards the neck and lower clavicle (collarbone).
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15
Repeat step 14 three times. This cleans the skin from any bacteria.
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16
Numb the marked spot using a 25-gauge needle. Insert the needle using a 45-degree angle and gently push the syringe to inject 1 cc of lidocaine.
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17
Look for skin puffiness around the needle. This shows that lidocaine was properly injected.
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18
Numb deeper structures using a 25-gauge needle. Repeat steps 17 and 18.
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19
Locate the subclavian vein (neck vein) and insert a 22-gauge needle at a 45-degree angle.
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20
Pull back on the syringe and make sure blood flows into the syringe. If so, you are in the correct spot.
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21
Remove the 22-gauge needle and insert an 18-gauge needle into that same spot on the subclavian vein.
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22
Press on the needle using your thumb and second finger. Do not let go and twist off the syringe from the needle.
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23
Thread half of the J wire into the 18-gauge needle.
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24
Hold the J wire in place with your fingertip and remove the 18-gauge needle by sliding it over the J wire.
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25
Make a small cut with a scalpel on the skin near the J wire and thread the silastic dilator over the J wire and toward the skin and into the chest.
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26
Remove the hub from the long central catheter and thread the catheter over the J wire.
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27
Attach IV tubing to the catheter and secure the catheter and tubing with sutures and ties.
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28
Place a clear dressing over the catheter and tube.
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