What is the proper procedure for using the Unico percutaneous set?

How to Use the Unico Percutaneous Set

The Unico percutaneous set should be used with maximal sterile barrier precautions including cap, mask, sterile gown, sterile gloves, and a sterile full-body drape to minimize infection risk during insertion. 1

Preparation

1. Gather equipment and prepare workspace:

   • Ensure all components of the Unico percutaneous set are available
   • Prepare a sterile field
   • Use ultrasound guidance if available to reduce cannulation attempts 1

2. Patient preparation:

   • Position patient appropriately (supine with neck extension for jugular access; supine with arm abducted for subclavian access)
   • Select optimal insertion site:
     • Avoid femoral vein in adults due to higher infection risk 1
     • Subclavian site is preferred over jugular or femoral sites to minimize infection risk 1
     • For right internal jugular vein, optimal insertion depth is 15 cm; for left internal jugular vein, 18-20 cm 2

3. Skin preparation:

   • Clean skin with 0.5% chlorhexidine preparation with alcohol 1
   • Allow antiseptic to dry completely according to manufacturer's recommendation 1

Insertion Procedure

1. Implement maximal sterile barrier precautions:

   • Perform hand hygiene
   • Don cap, mask, sterile gown and gloves
   • Apply sterile full-body drape 1

2. Anesthesia administration:

   • Apply local anesthetic to insertion site
   • Wait for adequate anesthesia effect

3. Venous access:

   • Use ultrasound guidance to locate the vein (reduces complications) 1
   • Insert introducer needle at approximately 45-degree angle
   • Confirm venous access with aspiration of blood

4. Guidewire placement:

   • Insert guidewire through the needle
   • Remove needle while maintaining guidewire position
   • Verify guidewire position with ultrasound or fluoroscopy if available

5. Dilation:

   • Make a small skin incision at the guidewire entry site
   • Insert dilator(s) over guidewire to create a tract
   • Remove dilator while maintaining guidewire position

6. Catheter placement:

   • Thread catheter over guidewire
   • Advance to appropriate depth (15 cm for right internal jugular, 18-20 cm for left) 2
   • Remove guidewire while maintaining catheter position
   • Verify all lumens are patent by aspirating blood and flushing with saline

7. Secure catheter:

   • Suture catheter in place or use sutureless securement device 1
   • Apply sterile dressing (transparent or gauze) 1

Verification of Placement

1. Confirm proper positioning:

   • Verify catheter tip position with chest X-ray (standard method)
   • Ideal position is at the junction between superior vena cava and right atrium 2, 1
   • Alternative verification methods include intraoperative fluoroscopy or intracavitary ECG 1

2. Post-procedure monitoring:

   • Monitor vital signs
   • Observe for complications (pneumothorax, hemothorax, air embolism)
   • Check insertion site for bleeding or hematoma

Maintenance

1. Dressing care:

   • Replace transparent dressings at least every 7 days 1
   • Replace gauze dressings every 2 days 1
   • Replace dressing immediately if soiled, damp, or loosened 1

2. Line care:

   • Flush catheter with saline after each use 1
   • Clean injection ports with 70% alcohol or iodophor before accessing 1
   • Minimize access to reduce infection risk

Infection Prevention

1. Ongoing care:

   • Use single-use sterile gel packets for ultrasound guidance 1
   • Maintain aseptic technique during all manipulations
   • Consider chlorhexidine-impregnated dressings for high-risk patients 1
   • Consider alcohol caps for needleless connectors 1

2. Remove when no longer needed:

   • Promptly remove catheter when no longer essential 1
   • Do not routinely replace central venous catheters solely to reduce infection 1

Common Pitfalls and Complications

1. Infection risk:

   • Failure to use maximal sterile barrier precautions significantly increases infection risk
   • Improper skin preparation increases colonization
   • Femoral site has higher infection risk than subclavian or jugular sites 1

2. Mechanical complications:

   • Pneumothorax, arterial puncture, hematoma
   • Improper positioning can lead to thrombosis, erosion, or arrhythmias 2
   • Catheter tip positioned too high increases thrombosis risk; too deep increases cardiac perforation risk 2

3. Post-insertion issues:

   • Catheter migration
   • Occlusion
   • Venous thrombosis

By following these guidelines, the Unico percutaneous set can be used safely and effectively for central venous access, minimizing the risk of complications and infections.