INDICATION: _ PROCEDURE OPERATOR: _ ATTENDING PHYSICIAN: _ In Attendance (Y/N)_ CONSENT: [_] During the informed consent discussion regarding the procedure, or treatment, I explained the following to the patient/designee:
a. Nature of the procedure or treatment and who will perform the procedure or treatment.
b. Necessity for procedure and the possible benefits.
c. Risks and complications (most common and serious).
d. Alternative treatments and the risks, benefits and side effects of each (including no treatment).
e. Likelihood of the patient achieving his/her goals without this procedure and surgery treatment.
f. Problems that might occur during the recuperation.
g. Conflicts of interest, if any
[_] The procedure was emergent, the patient was unable to provide consent, and a designee was not immediately available. PROCEDURE SUMMARY: 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, full gown and sterile gloves throughout the procedure. The patient was placed in Trendelenburg position. LEFT / RIGHT chest region was prepped using chlorhexidine scrub and draped in sterile fashion using a full drape and sterile probe cover and sterile gel employed. The medial and lateral heads of the sternocleidomastoid muscle were identified as was the carotid pulse. The Internal Jugular vein was identified using the ultrasound. Anesthesia was achieved over the vein using 1% lidocaine. Using real-time out of plane guidance, the introducer needle was inserted into the Internal Jugular vein under direct ultrasound visualization. Venous blood was withdrawn. The syringe was removed and a guidewire was advanced into the introducer needle. The guidewire was visualized in the Internal Jugular Vein by ultrasound. 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. Post-procedure chest x-ray is pending at this time. Estimated blood loss is _.