Exam 3: Central Line Principles

Question 1

Where can central lines (central venous catheter) be placed?

Answer 1

• External Jugular
• Internal Jugular (most common site)
• Subclavian
• Femoral

Question 2

Indications for central lines (7)

Answer 2

• Monitoring central venous pressure
• Infusion of caustic drugs
• Administration of TPN
• Aspiration of air emboli (wishful thinking)
• Insertion of transcutaneous pacing leads
• Venous access for people w/ poor peripheral veins
• Dialysis access

Question 3

Contraindications for central lines (4)

Answer 3

• Renal cell tumor extending into the right atrium
• Tricuspid valve vegetation
• Site infection
• Site specific

Question 4

Where do most central lines terminate at?

Answer 4

• Cavoatrial Junction

Question 5

The complications of a central line (5)

Answer 5

• Pneumothorax/Hemothorax
• Line-related infection
• Carotid puncture
• Dysrhythmias
• Trauma to nearby nerves

Question 6

What are the landmarks for placing a central line in the Internal Jugular Vein?

Answer 6

• The needle should be inserted at the triangle’s apex formed by the sternocleidomastoid muscles: sternal head and clavicular head.
• From the apex, aim at the ipsilateral nipple (same side), and insert the needle 45 degrees into the skin.

Question 7

Pt. Positioning for Central Line in the Internal Jugular Vein.

Answer 7

• Trendelenburg to decrease the risk of air embolism and increase venous return

Question 8

What areas are prepped if performing a central line on the right internal jugular vein?

Answer 8

• Chin
• Sternum
• Shoulder
• Neck
• Ear lobe

Prep the right AND left side of the neck and all the way to the NIPPLE line just in case.

Question 9

Where should the drape cover be if performing a central line?

Answer 9

• Head to foot
• Side to side

Question 10

What can be used for vein identification if an ultrasound is not available?

Answer 10

• 25 G seeker needle

Question 11

Pros and Cons of the Pig Sticker

Answer 11

• No catheter; guidewire threaded from the back end of the needle or syringe
• Pro: minimized movement; all parts stay together
• Con: No visualization of blood = artery vs. vein
  (shoot shoot shoot vs drip drip drip)

Question 12

What kind of motion is used to insert the J-wire?

Answer 12

• insert J-wire through needle or catheter in a twisting motion
  Nick skin to enlarge opening

Question 13

What should you never do with the J-wire?

Answer 13

• Never let it go of the J-wire when threading it into the patient.

Question 14

Catheter Distance
Right IJ:
Right Subclavian:
Left IJ:
Left Subclavian:

Answer 14

• Right IJ: 15 cm
• Right Subclavian: 14 cm
• Left IJ: 18 cm
• Left Subclavian: 17 cm

Question 15

Placement confirmation of central via ______.

Answer 15

• CXR
• Note catheter tip
• Make sure there is no pneumothorax, hemothorax
• No guidewire left behind

Question 16

What is used to secure a central line?

Answer 16

• Sutures
• Tegaderm
• Staples

Question 17

What do you see in the CXR?

Answer 17

• Left hemothorax
• Note how the left lung has a “meniscus sign”
• The right lungs costodiaphragmatic angle is sharp*

Question 18

What do you see in the CXR?

Answer 18

• Right pneumothorax
• The dark side of the chest is filled with air > 50%
• Needs chest tube

Question 19

Where is the Central Line?

Answer 19

• Right IJ

Question 20

Where is the Central Line?

Answer 20

• Left IJ

Question 21

What do you need to do when setting up for CVC placement?

Answer 21

Make sure check list is complete
Time out performed