Procedure Manual
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Comment on this procedure
POLICY: It is the policy of the Richmond Health Service that the insertion of Central Venous Catheters be undertaken by only qualified Medical Practitioners. Resident Medical Officers may undertake the procedure under the direction of a Senior Medical Officer and must be assessed as competent by Senior Medical Officer before attempting the procedure without supervision. The patient must be Cardiac monitored during the procedure in an electrically Cardiac isolated environment which conforms to Electrical Standard AS 2500, Section 4, 1986 .
STANDARDS: - The procedure will be performed under the strictest aseptic conditions.
- The procedure will be explained to the patient and written consent will be obtained by the Medical Officer.
- Universal precautions will be maintained throughout the procedure and in the clean up phase following the procedure.
- Patient safety will be maintained throughout the procedure.
OUTCOMES:
- The catheter will be located in Superior Vena Cava.
- The risk of infection will be minimised.
- The patient will feel safe and secure during the procedure.
- There will be a defined clinical benefit for the patient from the performance of
the procedure.
- The attendant risks involved in the performance of, and subsequent to the procedure
will be monitored and managed within defined protocols.
SPECIAL
CONSIDERATIONS:
- Resuscitation trolley should be readily accessible.
- Patient bed should be able to be tilted in the Trendelenberg position.
- The insertion site e.g. jugular or subclavian area, should be exposed and clear
of clothing, ECG dots, wires and jewellery.
- I.V Lines and infusion pumps should be primed with the prescribed fluid and ready
for connection.
- The audible QRS tone on the monitor should be turned on during the procedure.
- Chest X-Ray to be taken and reviewed by a medical practitioner as soon as practicable
post insertion of a subclavian line.
EQUIPMENT:
Surgical Mask (Doctor and Nurse) Sterile gown and gloves
1 large trolley drape 1 large patient drape
1 fenestrated drape Basic dressing pack
Alcohol Chlorhexidine 1 x 5ml syringe
1 x 10ml syringe 1 x 23g needle
1 x 19g needle 10mls 1% Plain Lignocaine
5 - 10mls Heparinised Saline 50 units in 5ml 2/0 Black Silk on straight cutting
needle
Stitch cutter
Hansipore dressing or Gauze dressing and Micropore tape
Central Venous Catheter as requested. (Add extra 5ml syringe for single lumen catheter).
NURSES ROLE:
The nurse:
- remains with the patient throughout the procedure.
- prepares the patient, removing clothing, exposing the site area, repositioning ECG
dots/wires.
- positions the patient in the Trendelenberg position.
- opens packs and sets up for procedure.
- observes Cardiac Monitor during insertion of the guidewire/catheter.
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SETUP AND INSERTION OF PULMONARY ARTERY CATHETER |
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