Central Venous Catheter Insertion: Assisting

Transcription

1 Approved by: Central Venous Catheter Insertion: Assisting Gail Cameron Senior Director, Operations, Maternal, Neonatal & Child Health Programs Dr. Santiago Ensenat Medical Director, Neonatology Neonatal Nursery Policy & Procedures Manual : Date Effective Next Review May 2018 Dr. Sharif Shaik Medical Director, Neonatology Purpose Policy Statement Equipment To provide guidelines for assisting with central venous line insertion. A central venous catheter may be inserted by a percutaneous or cut down method. The equipment needed and the assistance required varies slightly with the method and type of catheter chosen. Therefore, check with the individual inserting the line and equipment required. The operator may request that the infant be on a radiant warmer for the procedure. ALL Radiant Warmer Gown, gloves, hat, and mask for individual inserting catheter Hat & Masks for all individuals in the patient s curtained bedside or room where inserted Central Venous catheter Antiseptic solution (refer to Skin Antisepsis Policy) Flush for catheter port(s) as specified in Heparin Policy Luer lock straight extension set with appropriate end cap to maintain closed system Syringe for each catheter port (10 ml for PICC lines) Sterile Tray May come with catheter, or add a cutdown or dressing tray Sterile Drapes may be included in catheter or cutdown tray Dressing sterile, transparent, semi-permeable Infusion pump with infusion ready to be administered CUTDOWN OR OVER THE WIRE INSERTION #4-0 silk and #3-0 sutures may be on catheter tray Xylocaine 1% without epinephrine Catheter introducer PERIPHERALLY INSERTED CENTRAL CATHETER with BREAK AWAY NEEDLE Sterile scissors or scalpel blade to shorten the catheter (not recommended) when possible use the manufacture supplied PICC line cutter. Sterile steri-strips

2 Page 2 of 5 Procedure Before insertion consider the use of topical anesthetic preparation. ACTION 1. Attach cardiac and blood pressure monitoring. 2. Pull curtains around patient care area. Mask, hand wash, and prepare equipment and sterile tray. 3. Prepare flush solution by adding Heparin to normal saline according to Heparin policy 4. Restrain the baby as indicated by the person inserting the catheter. 5. Operator to gown for sterile procedure.. Place sterile salines flush on tray and provide Xylocaine as required. 6. Check heating method. Radiant Warmer switch heat control to manual if ISC probe covered by drapes. 7. Assist as necessary. This may include restraining a limb, or providing a tourniquet with the thumb and forefinger proximal to the insertion site (particularly with the PICC break away needle method). Ensure that operator removes chlorhexidine antiseptic with sterile water on infants < 28 weeks and 2 weeks of age. 8. Upon request, with the percutaneous break away needle method of inserting a catheter, stroke close to the insertion site along the vessel proximally or with RATIONALE This is an invasive procedure with potential for major complications air embolism, pericardial tamponade, pneumothorax, myocardial perforation, hematoma formation, large vessel thrombosis. Strict aseptic technique is essential, since sepsis is the most common complication. Curtains are drawn to minimize traffic and reduce potential for contamination. Heparinized flush is used to minimize thrombus formation on insertion of catheter. With cutdown methods, all limbs may need to be restrained for the procedure. The operator must wear a mask, hat, sterile gown, and sterile gloves for the procedure. The operator draws the flush into syringes and purges each of the catheter ports. Xylocaine or other topical anesthetic is used for cutdown and some percutaneous line insertions. To help maintain thermoregulation during the procedure. A tourniquet is used to dilate the vessel to facilitate the insertion of the breakaway needle. Chlorhexidene antiseptic may burn premature infant skin so it is removed after it is dried. Stroking and giving flushes help advance the catheter within the vein.

3 Page 3 of 5 syringe on catheter give small flushes of the heparinized saline solution. 9. Assist with securing the catheter as requested. Note in the chart and the Kardex the length of exposed catheter. Cutdown catheters are sutured in place and a dressing is placed over the insertion site. Percutaneous larger catheters may be sutured in place. Small silastic catheters are not. A sterile dressing is placed over the catheter at the insertion site. The remaining catheter is taped to prevent accidental dislodgement with tension on the lines. For PICC lines, they are secured with steri-strips. Accidental slippage of the catheter is minimized with secure suturing and/or taping of the catheter. A dressing is placed over the insertion site to reduce the chances of contamination. Slippage of the catheter can be detected if the catheter length is known. See policy for recommendation of dressing changes. Regular tape degrades some PICC material. 10. Heparin lock and clamp catheters. Heparin use and preventing blood back flow should prevent clotting until an infusion is started. 11. Wash antiseptic solution off of the skin with sterile water. To prevent skin burns. 12. Obtain an x-ray. To check placement of the line. 13. Begin infusion after confirmation with individual inserting the catheter. The catheter may need to be adjusted before an infusion can commence. 14. Use only Luer-Lock connections on IV lines. Hemorrhage or air embolism can occur if lines are disconnected. Related Documents RELATED POLICIES AND PROCEDURES Central Lines Central Line Dressing Heparin Use: Recommendations Skin Antisepsis Corporate Policy & Procedure Manual, Care of Central Venous Catheters - Tunnelled Number: VII-B-385, January 2015 Corporate Policy & Procedure Manual, Care and Removal of Central Venous Catheters Nontunnelled Number VII-B-380 January 2015 References Adapted with permission from Stollery Children s Policy and Procedure Manual: Central Venous Catheter Insertion: Assisting, March 2012 Perry, A. G., & Potter, P. A. (2014). Chap.28 Caring for Central Vascular Access Devices (pp ) Clinical Nursing Skills & Techniques (8 th ed). St. Louis, Missouri: MOSBY Elsevier

4 Page 4 of 5 Revisions July, 2004 April 2011

5 Page 5 of 5 Signing Original Signed GAIL CAMERON SENIOR DIRECTOR, OPERATIONS MATERNAL, NEONATAL & CHILD HEALTH PROGRAMS GREY NUNS & MISERCORDIA HOSPITALS June 15, 2015 DR. SANTIAGO ENSENAT MEDICAL DIRECTOR NEONATAL PROGRAM GREY NUNS HOSPITAL Original Signed DR. SHARIF SHAIK MEDICAL DIRECTOR NEONATAL PROGRAM MISERCORDIA HOSPITAL June 4, 2015