Indications include patients with multiple, incompatible intravenous (IV) medications with limited peripheral access, or who are being treated with vasoactive or phlebosclerotic agents which may not be suitably cared for with a peripheral IV alone. Outline a structured interprofessional team approach to provide effective care to and appropriate surveillance of patients undergoing central line placement.Ĭentral venous catheterization (CVC) is a procedure frequently required in acute or critical care resuscitation.Review the complications associated with central line placement.Describe the recommended patient position during central line placement.Identify the indications for central line placement.This activity reviews the indications, contraindications, and technique involved in performing central line placement and highlights the role of the interprofessional team in the care of patients undergoing this procedure. Most central lines are placed today via the Seldinger technique, which is safer than the previously used "cut-down" technique. Central lines may also be placed to introduce Swan Ganz catheters to measure internal hemodynamics of the heart, or to introduce temporary transvenous pacemaker leads in the critically ill patient who has severe bradycardia or high-degree heart block these are called introducer catheters. Some central lines are also placed for temporary or permanent hemodialysis access these dialysis catheters are significantly larger than traditional double, triple, or quadruple lumen catheters placed in the emergency department or intensive care unit setting. Indications include patients with multiple, incompatible intravenous (IV) medications with limited peripheral access, or who are being treated with vasoactive or phlebosclerotic agents which may not be suitably cared for with a peripheral IV alone. No fault was found with the lumina and the valve of the catheter.Central venous catheterization (CVC) is a procedure frequently required in acute or critical care resuscitation. The catheter was returned to the manufacturer to check. The authors are unaware of any previous reports on this problem, and we are unable to explain the cause of-this event. Fortu-nately, the patient did not experience awareness during the anesthesia. We changed the infusion line for propofol. Inotropes and vasopressors were infused through the 15-gauge lumina, and propofol (5 mg ĭuring cardiopulmonary bypass, we noticed that the inside of a drape of the Swan-Ganz catheter was filled with propofol ( Figure). It was sutured in place at the skin entry point and at the hub, and an 8.5F flow-directed pulmonary catheter for monitoring was placed via the side port of the middle (9F) lumen. After induction of anesthesia with fentanyl and propofol, the Advanced Venous Access was inserted into the right internal jugular vein. We report an unusual leak in this catheter during surgery.Ī 73-yr-old, 52-kg, 155-cm ASA physical status II man with effort angina was scheduled for coronary artery bypass grafting. It is designed to allow insertion of a flow-directed pulmonary catheter through the side port of the 9F middle lumen without requiring another venous puncture. This catheter for central venous access has three lumina, one 9F middle lumen and two 15-gauge lateral lumina. The Advanced Venous Access(Edwards Lifesciences Irvine, CA) was introduced into anesthesia practice for use in patient management of these cases. Central venous catheterization is essential in patients who undergo cardiac or other surgeries.
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