Peripheral access central venous catheter insertion technique.
Insertion of a peripheral access drum-type central catheter into a peripheral vein.
Objectives:
– To maintain a central access for diagnostic purposes or in case of emergency. – To administer fluids, drugs, total parenteral nutrition or blood products to the patient.
Equipment:
– Trolley or trolley for cures. – Compressor. – Sterile drapes. – Fluid therapy equipment. – Sharps container.
Material:
– 1 pair of sterile gloves. – 1 pair of non-sterile gloves. – Sterile dressings. – Sterile gauze. – 1 Drum® central catheter. – Antiseptic solution. – 1 bandage. – Fixative dressing – Necessary material for fluid therapy. – Nursing records.
Procedure:
2 team members are needed: – 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 supine position with the arm extended in external rotation forming a 90º angle, the patient’s head turned to the side of the patient. – Proceed to alcoholic disinfection of the hands. – Put on non-sterile gloves – Select the vein to puncture (basilic or cephalic at the level of the elbow flexure). – Remove the gloves. – Place the sterile drape under the arm to be punctured. – Put on the sterile gloves. – Clean the area with antiseptic solution and let it dry. – Prepare the sterile field and place the material on it. – Place the compressor 10-15 cm above the puncture site (the placement of the compressor is done by the collaborating staff, if not available change sterile gloves). – Check that the catheter is in good condition. – Fix the skin so that the chosen vein does not move. – Insert the catheter with the bevel upwards and at an angle not exceeding 30º. – Remove the compressor (2nd person) when blood refluxes into the catheter. – Start inserting the catheter slowly by turning the drum clockwise until the desired length is inserted. – Do not force, if there is resistance, remove the catheter and start over. – When the catheter has been inserted, remove the guide or clamp. – Ensure accurate placement of the catheter tip by measuring the distance from the point of insertion to the right third intercostal space with the guide. – Connect the infusion set, checking the permeability (the solution to be infused is physiological saline solution, until the exact placement is verified by X-ray). – Clean puncture site with antiseptic solution. – Place sterile gauze impregnated with antiseptic and roll excess catheter on top of them to prevent kinking. – Place sterile dressing and fix with elastic bandage. – Hold the infusion system to avoid traction or kinking. – Dispose of sharps in the appropriate container. – Collect the material. – Leave the patient in a comfortable position. – Remove gloves. – Perform hand washing. – Record in the nursing documentation: procedure, reason, date and time, incidences and patient’s response.
Observations:
– Use one catheter for each attempt. – Check its placement radiologically and if it is too far in, remove a few centimeters. If it is in the superior cava, remove and reinsert. – Monitor the patient’s pulse for tachycardia, which may be due to the catheter being in the ventricle instead of the atrium.
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