Central Line Procedure Note
Indication:
[_] Hypotension/Sepsis/Need for Pressors
[_] Vascular Access
[_] Dialysis Access
[_] Suspected Central Line Infection
[_] Line Malfunction
[_] Other: _
Central Line Location: [_] Right or [_] Left
[_] Internal Jugular Vein or [_] Subclavian Vein or [_] Femoral Vein
Procedure Operator: _
Attending Physician: _
Present During Procedure?: [_] Yes [_] No
Consent:
[_] Consent was obtained from _ prior to the procedure. Indications, risks and benefits were discussed prior to the procedure.
[_] The procedure was performed emergently and the permission was implied because of the emergent nature.
Doctors _ and _ confirmed the emergent nature of the procedure and signed consent form prior to the procedure.
PROCEDURE SUMMARY:
The CDC Central Line Insertion Practices form was completed by _ during and immediately following the procedure. 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. The [_] Left [_]Right [_] neck [_] chest [_] groin was prepped using [_] chlorhexidine scrub (or [_] other: why _) and draped in sterile fashion using a three quarter sheet drape and sterile towels. Skin preparation was allowed to dry prior to skin puncture. Anatomic landmarks were identified. Anesthesia was achieved over the vein using 1% lidocaine. Using real-time ultrasound, with sterile probe cover and sterile gel, the introducer needle was inserted into the 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 Venous blood was withdrawn.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 appropriate 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 an [antimicrobial coated] _ central venous catheter. The wire was removed and the catheter was sutured in place at _ cm. A biopatch was placed at the insertion site. A sterile op-site was placed over the catheter and biopatch. 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.
[_] Shows adequate positioning of the catheter for use.