Assisting Central Venous Catheter (CVC) Insertion Procedure

Introduction:

A central venous access catheter, also known as a central line, is a sterile catheter inserted in
a large vein as (internal jugular, subclavian, and femoral). These long, flexible catheters
empty out in or near the heart, allowing the catheter to give the needed treatment within
seconds.
Purposes of insertion:

 Volume resuscitation
 Nutritional support
 Administration of emergency medications ( vasopressors)
 Central venous pressure monitoring
 Hemodialysis

Contraindications to CVC:

 Local infection
 Distorted local anatomy
 Coagulopathy
 Previous radiation therapy
 Suspected proximal vascular injury
 Traumatized site (eg. clavicle fracture and subclavian line)
 Burned site

Equipment:

1. Materials required for CVC insertion

 1% lidocaine
 26-GA needle syringe
 2 cc syringe for anesthetic
 10 cc syringe for flushing
 Gauze
 Betadine or antiseptic solution
 Gloves (sterile)
 Catheter device
 IV tubing
 IV solution
 Needle holder
 4-0 Silk or nylon sutures
 Suture scissors
 CVC dressing
 Sterile drapes

1|Page
 2. Ancillary equipment for CVC
 Oxygen supply
 Pulse oximeter and Blood pressure cuff
 Crash cart with cardiac monitor

Complications of central venous cannulation

Immediate

 Pneumothorax
 Haemothorax
 Arterial puncture
 Local haematoma
 Guidewire-induced arrhythmia
 Air embolism

Late

 Vascular erosion
 vessel stenosis
 Thrombosis

Remember to:

 Sometime the procedure is guided by Ultrasound

Ultra sonographic features which distinguish the internal jugular vein from the carotid
artery to reduce the risk of insertion related complication

2|Page
 Assisting Central Venous Catheter (CVC) Insertion Procedure
# Steps Rational
Pre procedure:
1. Wash hands To minimize infection
2. Prepare equipment To save time
3. Introduce youreslf to patient To build trust
4. Identfiy the patient To ensure that is the right patient
5. Explain procedure to the patient The patient may be very anxious and it is important
that the nurse gives a clear explanation and
reassurance before, during and after the procedure.
6. Keep patient privacy To minimize embarrassment
7. Put patient in correct position To encourage venous engorgement, which makes it
The patient should lie supine and the head easier to puncture the vein and reduce the risk of air
of the bed should be lowered embolism
Trendelenburg position(10-15) in case of
internal jugular and subclavian CVL

8. Put disposable pad /dressing under the To prevent infection transmission

venous access
9. Attach patient to cardiac monitor and pusle
Monitor heart rate & rhythm, respiratory rate &
oximeter if avalable
patient response throughout the procedure.
Watch cardiac monitor closely as guidewire &
catheter are inserted & notify physician
immediately if dysrhythmia occurs.
10 Disinfectant your hands To reduce infection
11 Wear Face Mask To prevent infection transmission to the insertion site
12 Ensure that all attinding staff in the area of To prevent infection transmission to the insertion site
the bedside wear a mask
13 Wear clean gloves To prevent infection transmission
During procedure :
14 To prevent infection transmission to the insertion site
Perpare the insertion site by cleaning the
.
insertion site if it is visibly soiled

15 To facilitate insertion.
Turn or instruct patient to turn head away
from insertion site.
16 Explain what is happening throughout the To ensure patient comfort during the procedure.
procedure While the physician disinfecting
the area.

3|Page
17 To prevent infection transmission to the insertion site
Perpare a sterile field on the bed side
table and Make sure to have some spare
gauze swabs ready.

18 Assist physiacian to anestheize the area

with lidocaine by perparing needed
equipment

19 To maintain aseptic technique and save time.

Assist physician to put on a sterile gown

20 Ensure that physacian drapes the patient To sterile field and to comply with maximal barrier
with large sterile drapes percaution.

CVC Insertion Steps by Physician(seldinger)

4|Page
2 To prevent complication during insertion
Monitor heart rate & rhythm,
1
respiratory rate & patient response
throughout the procedure. observe
cardiac monitor closely as guidewire
& catheter are inserted & notify

5|Page
 physician immediately if dysrhythmia
occurs.

2 Assist physician with flushing of catheter

2 ports with normal saline

2 Assist physician with Secure catheter by

3 suture by handlining the needle by needle
holder

2 Secure catheter by CVC transparent

4 Dressing

2 Label the dressing with data , the time To ensure proper identification and documentation.
5 and your intials of physicain.
2 Mak sure that all lumen clamps are closed To prevent air embolism
6

2 Return patient in comfort position To promot patient comfort

7

6|Page
2 Intiate IV therapy if perscribed after an X
8 rays comfirms correct placement in the
superior vena cava

2 Reasses patient patient after 30 mins To assess any signs of insertion related commplication
9
Post procedure:
3 Dispose any used material To reduce infection
0
3 Remove gloves To reduce infection
1
3 Wash hands To reduce infection
2
3 Record the procedure Documentation provides ongoing data
3
3 Report any abnormalitis such as sudden To ensure patient safety
4 dyspnea, pallor, tachycardia.

Reference:
- Delves-Yates, C. ed., 2018. Essentials of nursing practice. Sage.
- Lynn, P., 2018. Skill Checklists for Taylor's Clinical Nursing Skills. Lippincott Williams
& Wilkins.

7|Page