Central line insertion procedure note

A central line is a type of catheter that is placed in a large vein that allows multiple iv fluids to be given and blood to be drawn. Internal jugular central line procedure note ventura family. The insertion of all arterial and central venous lines should adhere to the central venous and arterial line safety checklist and procedure note. Thorough completion of the new standardized central line insertion note currently available in cis. Internal jugular central line procedure note ventura family med. This video will demonstrate the placement of a central venous. Cleanse a 1520cm area with povidoneiodine solution.

Jan 07, 2012 perfusion to the extremity distal to the point of catheter insertion was checked and found to be adequate. Accessing a central venous catheter by mary jeanne manning, please note that in this video we will be following the guidelines used at boston childrens hospital. Standardized procedure central line placement and temporary. Central line insertion care team checklist instructions operator requirements. Resident physician who has completed the competency phase b. We will use the terms central line and triple lumen catheter tlc interchangeably in this article. Trainees is proficient in central line insertion in all circumstances in site specific manner, see below for site specific competency.

Verbiage in line properties section of procedure note. Nov 19, 2010 central venous line placement is typically performed at four sites in the body. Limited ultrasoundguided right internal jugular central line placement. Get to know the equipment in the standard central line placement kit. This new list of codes identifies several factors that should guide the codes you use when you insert central venous catheters. Preprocedure verification prior to any elective line insertion the nurse and physicians should complete a preprocedure check or time out. I wore a surgical cap, mask with protective eyewear, full gown and sterile gloves throughout the. Sample procedure note for documentation of central line insertion, from roxborough memorial hospital and the pennsylvania patient safety authority. Avoid same side as dialysis graft, pacemaker, and mastectomy. In previous years, there were only a handful of codes to choose from when inserting a central line. Aorta, pulmonary artery, superior vena cava, inferior vena cava, brachiocephalic veins, internal jugular veins, subclavian veins, external iliac veins, and common femoral veins. The placement of a central venous line is an essential technique in the treatment of many hospitalized patients.

Imaging guidance, including ultrasound or fluoroscopy, can be reported in addition to the procedure. Cpt codes 36595 and 36596 are reported for the removal of obstructed material. Cpt codes 36589 and 36590 central venous access device are reported for the removal of a tunneled central venous catheter. It may be associated with considerable discomfort in the conscious patient, as it requires himher to stay in trendelenburg position, headextended with the neck fully turned to the opposite side. Patient preparation and position for right ij central line placement. A central venous catheter cvc, also known as a central line, central venous line, or central venous access catheter, is a catheter placed into a large vein. Activity procedure rn lpn uap access infusion device to administer.

Standardized procedure central line placement and temporary nontunnelled central venous dialysis catheter insertion adult, peds 3 iv. Uncomplicated placement of right upper extremity double lumen picc line. Central venous cannulation is a relatively common procedure in many branches of medicine particularly in anaesthesia and intensive care medicine. Placement of larger catheters in more centrally located veins is often needed in critically ill patients, or in those requiring prolonged intravenous. A template that can be used to write a post procedure note following placement of a central line femoral, internal jugular, subclavian. Locate a spot 12cm below the clavicle where the proximal and distal 23 of the clavicle meet.

A long catheter may be advanced into the central circulation from the antecubital veins as well. Central venous catheters insertion saskatoon health. Central line insertion training program station 2 page 1 of 2 presentation title. This new list of codes identifies several factors that should guide. Cvc subclavian central line kings county hospital suny. Why a central line is necessary and associated risks. Femoral central line procedure note ventura family medicine. Because just about every medical facility in the us has ultrasound available, there is no excuse not to use it while placing a central line.

Procedure technique, sterile prep, anesthetic, amount of fluid obtained, character of fluid, estimated blood loss any complications tests ordered references central line placement with and without ultrasound guidance. When the needle is inserted in a 45 degree angle, the path of the needle is approximately 1. Correct implementation of the seldinger technique and in the following order has not resulted in any known evidence of complications as it relates to the guide wire or venous catheter. The patient was placed in appropriate dependent position for central line placement. Using the 25 ga blue needle, make a wheal under the skin at the desired spot, and. Picc tip location in the svc confirmed by ecg technology. Apr 07, 2008 the patient tolerated the procedure well. Nurses and physicians should use proper hand hygiene soap and water or hand gel prior to inserting, accessing or dressing any central line. It is imperative to assess each individual as competent to perform insertion and removal of a cvc. Arterial puncture and cannulation, also known as arterial line placement or aline, is commonly performed in the ed to allow for continuous blood pressure measurement and frequent arterial blood gas sampling. Infusion therapyinsertionaccess procedures position statement for rn, lpn and uap practice page 2 of 2 north carolina board of nursing po box 2129 raleigh, nc 27602 919 7823211 fax 919 7819461 nurse aide ii registry 919 7827499. Ecg done by iv nurse verbiage at end of procedure note.

Patients right left ijsubclavian femoral area was prepped and draped in usual sterile fashion. My hands were washed immediately prior to the procedure. Jan 07, 2012 the patient was placed in name the position. Successful insertion of a minimum of total of 15 cvc placements at femoral and ij sites. Central line insertion procedure note patient safety topic. Seldinger technique for central intravenous iv line placement. Pennsylvania patient safety authority 333 market street, lobby level. Drape the patient with the provided paperplastic drape and turn the patients head to the opposite side.

Central line insertion practices clip adherence monitoring. Central line insertion procedure note patient safety authority. A timeout was completed, verifying correct patient, procedure, site, positioning, and implants or special equipment if applicable. Neither the location of the insertion site nor the type of device may be used to determine if a line qualifies as a central line. The internal jugular is usually preferred to subclavian approach where possible as it is less likely to lead to pneumothorax indications for central line central venous catheter.

The internal jugular is usually preferred to subclavian approach where possible as it is less likely to lead to pneumothorax indications for central line central venous catheter insertion administration of medications that require central access e. Perfusion to the extremity distal to the point of catheter insertion was checked and found to be adequate. You can delete for central line insertion since you can title the note as such. A chest xray was ordered to evaluate for placement of the chest tube.

When compared to a typical iv line, a central line is larger, can stay in place longer, can deliver a greater volume of fluids and allows blood to be drawn easily. Assess clinical necessity for central or dialysis catheter, coagulation status, and ability of patient to cooperate with procedure. Pennsylvania patient safety authority 333 market street, lobby level harrisburg, pa 17101. Generic arterial line kits include separate needle and wire components, as would be used to place a central line. By february 1, 2008, physicians desiring to insert central lines must complete the duke module available on the internet. Central venous catheter 7fr triplelumen 15cm long catheter most common note kits vary and most kits will also have other equipment from the rest of the list included. It is recommended to place the patient on cardiopulmonary monitoring for the duration of the procedure. These forms should be completed and placed in the progress note of the clinical records. If a cvc is changed over an existing line using a guidewire, steps need to be taken to maintain sterile technique. The insertion of a central venous catheter cvc is one of the most frequently performed invasive procedures in anesthesia and critical care settings. Immediately prior to procedure a time out was called to verify the correct patient, procedure, equipment, support staff and siteside marked as required.

In the last post the central line part 1 we focused on the. Central line central venous catheter insertion central line insertion should be realtime ultrasound guided. Subclavian central line procedure note ventura family med. Procedure for central line central venous catheter insertion. An estimated 200 000 central venous access procedures are carried out each year in the united kingdoms national health service and over 5 million in the united states. Vascular access procedure note pdf icon pdf 118 kb external icon sample procedure note for documentation of central line insertion, from beth israel medical center. Pain and discomfort management during central venous catheter. Tap central lineassociated bloodstream infections clabsi.

Consent was obtained and a timeout was completed verifying correct patient, procedure, site, and positioning. Alternatives include the external jugular and femoral veins. Central line bundle to be performed prior to line insertion. Central line insertion techniques presentation objectives. Central line central venous catheter insertion oxford. It is also commonly a technique used in placement of an arterial line a line in the radial or femoral artery when continuous blood pressure monitoring is needed. The providers skill in inserting a cvc is a key component of safety and prevention of clabsi. Central line central venous catheter insertion oxford medical. If an insertion attempt is unsuccessful, report a new clip event only if a new. The patient tolerated the procedure well and there were no complications.