PROCEDURE OPERATOR: _
ATTENDING PHYSICIAN: _ In Attendance (Y/N)_
Ultrasound Used: Y/N
Consent was obtained from _ prior to the procedure. Indications, risks, and benefits were explained at length.
The CDC Central Line Insertion Practices form was completed by an independent observer (_) starting with the first handwash prior to starting sterile technique. A time out was performed. My hands were washed immediately prior to the procedure. I wore a surgical cap, mask with protective eyewear, sterile gown and sterile gloves throughout the procedure. The LEFT/ RIGHT inguinal region was prepped using chlorhexidine scrub and draped in sterile fashion using a three quarter sheet drape and sterile towels. The femoral pulse was identified. Anesthesia was achieved using 1% lidocaine. Palpating the femoral pulse throughout the procedure, the introducer needle was inserted Medial to the femoral artery, inferior to the inguinal crease and into the Femoral vein. Venous blood was withdrawn. The syringe was removed and a guidewire was advanced into the introducer needle. A small incision was made at the skin surface with a scalpel and the introducer needle was exchanged for a dilator over the guidewire. After appropriate dilation was obtained, the dilator was exchanged over the wire for a _ central venous catheter. The wire was removed and the catheter was sutured in place at _ cm. A sterile sorbaview shield was placed over the catheter at the insertion site. The patient tolerated the procedure without any hemodynamic compromise. At time of procedure completion, all ports aspirated and flushed properly. Estimated blood loss is _.