HOW TO….Ultrasound Central Line

EQUIPMENT

STANDARD OF CARE Most providers no longer use

landmarks for central line placement except for with subclavian lines and occasionally femoral lines

Increased accuracy Increased efficiency Ability to confirm placement in real

time

WHY USE ULTRASOUND…

ANATOMY

POSITIONING Trendelenburg positioning Phythagorean theorem

PRIOR TO THE PROCEDURE Order in EPIC the “ultrasound ED

bedside” prior to the procedure. At the ultrasound machine click the new

patient button and click on the worklist at the bottom of the screen.

Select the pt from the list. Enter your name under operator and press exit.

Now you will be able to save images for your central line.

WHAT YOU’LL NEED The Site Rite or the Zonare US machines Sterile US probe Cover Sterile Gloves Betadine/Chlorhexidine Sterile saline/ Blue caps Central Line Kit

Should have everything else you need A nurse/tech ready to help if you need

anything else

SELDINGER TECHNIQUE Still use the Seldinger technique

Needle Wire remove needle Small incision at skin dilator back thread the wire through the triple lumen Remove wire suture in place

Never let go of the wire

Difference is you can use the US to see the vein and vein puncture

http://www.youtube.com/watch?v=cYzVPMQc3aY&feature=related

DOCUMENTATION Please type .procdoc under the procedure

section of your note. Click on the blue hyperlink for your ultrasound order.

You do not have to fill out the information, just write “see note” in the comments section.

Then go to your note and use the .EDUS smartphrases to document your findings. Using the central line documentation under procdoc will work. Self made ones may not if they do not include the line “Wire seen in vein and images saved to patients permanent record.”

CONFIRM

CONFIRM

PEARLS/PITFALLS Failure to identify the needle in the tissue. 

Failure to distinguish between vein and artery. 

Angling the transducer towards the entry site of the needle on the skin may help visualize the needle earlier.

Avoid advancing the catheter if the needle tip is not visualized.

Trendelenburg position, Valsalva Maneuver,

Use caution when utilizing a long axis approach to central venous cannulation due to the inability to maintain visualization of the carotid artery at all times.

Sterile US gel

Failure to document with .procdoc and .edus smartphrases