Central Line Procedure Presentation Outline
A comprehensive central line insertion procedure presentation should follow evidence-based guidelines to minimize complications and maximize patient safety. The following outline covers all essential aspects of central venous catheter placement based on current guidelines.
I. Introduction and Importance
- Definition of central venous access
- Common indications for central line placement
- Types of central venous catheters (fully implantable, tunneled, non-tunneled, PICC)
- Impact on patient outcomes and mortality
II. Pre-Procedure Preparation
- Patient selection and assessment
- Informed consent process
- Equipment preparation and standardization
- Catheter selection (smallest size and minimum number of lumens needed) 1
- Vein selection algorithm based on clinical scenario 2, 1
- Team preparation and role assignment
III. Infection Control Measures
- Hand hygiene protocols 1, 3
- Maximal barrier precautions (sterile cap, mask, gown, gloves, full-body drape) 2, 1
- Use of chlorhexidine-alcohol solution (minimum 2% CHG) for skin antisepsis and allowing complete drying before puncture 2, 1
- Antimicrobial considerations (coated catheters for short-term use) 2
- Avoidance of femoral site due to increased infection risk 2, 1
IV. Procedural Technique
- Patient positioning (Trendelenburg for neck/chest access) 1
- Real-time ultrasound guidance for vessel localization and venipuncture 1
- Anatomical landmarks for different approaches:
- Seldinger technique step-by-step
- Catheter advancement and positioning
- Securing the catheter
- Verification of placement (radiological confirmation) 2
V. Post-Procedure Care
- Immediate post-procedure assessment
- Chest X-ray confirmation of placement and exclusion of pneumothorax 2, 1
- Vital sign monitoring (every 4 hours: temperature, pulse, BP, respiratory rate) 2
- Dressing application (sterile, transparent) 1
- Documentation requirements
VI. Maintenance Protocols
- Dressing changes (no more than once weekly unless soiled) 1
- Routine flushing with saline after completion of infusion or blood sampling 2
- Maintenance schedule:
- Access port disinfection before use 1
- Administration set replacement (every 7 days, 24 hours after blood products) 1
- Daily assessment of catheter necessity 1
VII. Complications and Management
- Immediate complications:
- Pneumothorax
- Arterial puncture
- Air embolism
- Malposition
- Arrhythmias
- Delayed complications:
VIII. Diagnosis of Catheter-Related Infections
- Clinical signs and symptoms
- Blood culture collection protocol: paired samples from catheter and peripheral vein 2
- Differential time to positivity method 2
- Culture techniques for removed catheters 2
IX. Treatment of Catheter-Related Infections
- Empiric antibiotic therapy (vancomycin recommended) 2
- Catheter removal indications:
- Tunnel infection or port abscess
- Septic shock
- Fungal or highly virulent bacterial infection
- Endocarditis or other metastatic infections 2
- Antibiotic lock technique for salvage attempts 2
- Duration of therapy based on pathogen
X. Prevention Strategies and Quality Improvement
- Bundle approach implementation 4
- Checklists and protocols
- Staff education and competency assessment 1
- Surveillance of central line-associated bloodstream infections 1
- Quality improvement initiatives
XI. Special Considerations
- Pediatric patients
- Patients on anticoagulation
- Patients with anatomical variations
- Emergency situations
XII. Simulation and Hands-On Practice
- Ultrasound technique practice
- Sterile technique demonstration
- Troubleshooting common issues
This outline provides a comprehensive framework for a central line procedure presentation, incorporating the most current evidence-based guidelines to ensure optimal patient outcomes and minimize complications.