Just like with all other procedures, the speed and success of your central line placement is mostly dependent on how you set everything up. There are many different kits and everyone has their own preferences, so take from this what you will. In this post, you’ll read what I’ve found makes my lines go smooth like buttah and my reasoning for what I do. Take from it what you will!
Use an Equipment and Pre-Sterility Checklist
I strongly recommend using a pre-sterility and equipment checklist. There’s nothing worse than being alone and fully gowned up in a cramped room and realizing that there’s something you forgot to move or grab before getting sterile. It just straight up sucks. Using a checklist prevents that from happening.
Know How to Get Sterile Without an Assistant
Steps:
- Don mask then boufant cap
- Open and lay out your gloves
- Open your gown, hold it by the neckline/velcro and gently shake it out
- Grab the velcro part, if you aren’t already and velcro it behind your neck, then slip your arms into the sleeves.
- Don your sterile gloves
It turns out ER nurses generally have better things to do than stand there and help you dress yourself. Being self sufficient in this way will make it easier for you to get this procedure done without having to wait on someone to be there to help you out.
Equipment Layout – Use the Tray
- Remove the unnecessary stuff, use the tray for the line itself
- Discard the unnecessary stuff, lay out the probe cover, lidocaine supplies, and gauze+line securing supplies in separate piles.
Introducer Needle Selection – Use the One with the Angiocath on it
- Put the needle with angiocath on your syringe, keep the original needle available in the tray
- The main advantage of the needle with the angiocath is that once it is within the lumen of the vessel, the angiocath can be advanced and the needle can be removed. This prevents you from accidentally going through the vessel or coming out of the vessel with your needle when you are trying to insert the wire. It also makes it easier to manipulate the wire within the vessel when troubleshooting a wire that is difficult to pass.
- The needle that is preloaded on the introduction syringe does have an area of increased echogenicity at the tip of the needle, so if you have difficulty visualizing the needle with the angiocath on your US machine, switch back to the original needle.
- take the cover off of the wire, grab the blue tip so that you don’t accidentally remove the straightening guide piece.
Grab the Cone When Uncapping Your Wire
Pre-Flushing the Catheter is Unnecessary and Slows You Down
- Don’t pre-flush the catheter, just remove the caps
- Pre-flushing is an unnecessary step. Allow the line to back-fill with blood and then place luer locks and aspirate then flush. As long as the line back fills with blood, there is no risk of air embolus. The risk of forgetting to pre-flush is the same as the risk of forgetting to aspirate.
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