Radial line

 Have sterile gloves, iodine prep and 4x4 and gaze ready
 Put on sterile gloves
1. Set up tape block to patient hand
2. Have patient extend
3. Feel for radial pulse
4. Sterile gloves open Iodine prep area
5. Hold catheter and needle - Go right below the artery, hold at 45 degree angle
6. Go closer to the bone, put needle thru skin
7. Have flash and push catheter off
8. Flush a-line
9. Check BP

Central line - IJV

 Open gown and gloves sterile
 Make sure patient is titled down 5 degrees

1. Turn head opposite side

2. Find two heads of the SCM (at sternal notch)
 Go superior and medial
 IC is medial
3. Put on gown and sterile gloves
4. Chlorohexidine/iodine prep
5. Put U/S jelly in probe cover and put probe cover on U/S. Hold probe, make sure
needle goes parallel and perpendicular
6. Numb area with lidocaine
7. Hold needle and catheter with two fingers and use a third to pull back, negative
pressure
8. Go thru skin, don’t go too deep (otherwise puncture lung or hit artery)
9. Stop pushing plunger back once see blood
10. Remove needle
11. Push guidewear
12. Thread catether over guide wire
13. Triple lumen tube
14. Saline flush - pull back to get blood and remove air

Suture across two things, loop around and third thing  tie surgical knot

 How to put on surgical gown

 How to put on gloves
 A-lines
 Central lines
 IVs
 How to preround ICU patient
 Read gagan sent me
 Read metabolic acidosis chapter in ICU book
 RASS scale for sedation
 Tube feedings up to date