Set of activities performed by the nurse together with the physician for the insertion of a central catheter by venous route until it reaches the subclavian, internal jugular or femoral vein.
Objectives:
– Maintain a permeable central access for diagnostic purposes. – Administer fluids, drugs, total parenteral nutrition or blood products to the patient.
Equipment:
– Cure trolley or trolley. – Sterile drapes. – Fluid therapy equipment. – Sharps container.
Material:
– 2 pairs of sterile gloves. – 2 pairs of non-sterile gloves. – Gown, cap and mask. – Transparent sterile dressings. – Sterile gauze.
– Central catheter: multilumen, Hickman®, etc. – Antiseptic solution. – Local anesthetic. – Syringes of 5-10 c.c. – Intramuscular needles. – Diluted sodium heparin (commercial preparation). – Physiological saline solution. – 3-4 obturators. – Scalpel – Suture: silk nº 0-1 with curved needle. – Hypoallergenic plaster. – Necessary material for fluid therapy. – Nursing records.
Procedure:
Catheter placement is usually performed by the physician: – Perform hand washing. – Prepare the necessary material. – Preserve the patient’s privacy. – Inform the patient of the procedure to be performed. – Ask for the patient’s cooperation.
Place the patient in the appropriate position according to the vein to be cannulated:
a) Subclavian: supine decubitus, arm on the side to which the subclavian vein is to be cannulated close to the body and the head turned to the opposite side and in Trendelemburg position. b) Jugular: decubitus supine and the neck turned to the opposite side. c) Femoral: supine decubitus with the legs in adduction and in slight external rotation. – Proceed to alcoholic disinfection of the hands. – Put on non-sterile gloves. – Clean the area with antiseptic in circular movements and allow to dry. – Collaborate with the physician in the preparation of the sterile field and during the procedure. – Once the physician has cannulated the line and performed the suture fixation, heparinize the lights that are not going to be used. – Remove gloves. – Place sterile dressing. – Check the correct placement of the catheter by X-ray. – Dispose of sharps in the container provided for this purpose. – Collect the material. – Leave the patient in a comfortable position. – Remove gloves. – Wash hands. – Record in the nursing documentation: procedure, reason, date and time, incidences and patient’s response.
Observations:
– Sterile technique
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