central line procedure, discontinuing
- 0Jul 18, '06 by opeloI am not sure if this is where I post. Would like to hear specifically on how some other hospitals have their procedures read in terms of discontinuing a central line, eg subclavian. Do most of you apply an occlusive dressing? Please comment.
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- 0Jul 18, '06 by meownsmileWe discontinue a central line by covering with gauze dressing and holding pressure for 5 min. Patient is told the dressing can come off next day. We dont use tegaderm or any kind of occlusive dressing when its taken out but they are covered with occlusive dressing when they are in place and being used.
We also have a C&S done on the line tip when we discontinue it.
- 0Jul 18, '06 by CrocutaWe have the patient positioned supine without a pillow, don sterile gloves, remove any sutures, hold 2x2's soaked with betadine over insertion site, have patient perform valsalva if able (or hold breath if not) and withdraw catheter. Pressure is held for 5 to 10 minutes and then an occlusive microfoam dressing is applied. Patient is then left flat for 30 more minutes.
- 0Jul 20, '06 by CritterLoverthe "why" is to prevent an air embolism....it is theoretically possible to suck air through the hole that the central line left until it is healed over. i think that in our facility, we are supposed to use some kind of petroleum-based ointment under a sterile gauze dressing once the line is pulled. but, i hardly ever d/c central lines where i work, so i'd have to look it up. (now that i think about it, i have never d/c'd a cvl at my current facility, but i have read the policy a few times, and i think i'm remembering right)
the posibility of an air embolism is very remote, but i guess it could happen. so some kind of occlusive dressing is probably best practice....either a tegaderm type dressing, or an oily ointment under a gauze dressing.
- 0Jul 23, '06 by mach1of8Quote from opeloIt is not remote. It will happen, and it can kill....this is precisely why doctors always have the patient laying flat head below heart upon insertion of central lines. Follow the procedure posted by Crocuta and the advise of critterloverI have never had problems with gauze dressing post dcing central lines; the possibility of an air embolism is so very remote and I have never experienced it over many years!
- 0Jul 23, '06 by jmgrn65Quote from mach1of8It is not remote. It will happen, and it can kill....this is precisely why doctors always have the patient laying flat head below heart upon insertion of central lines. Follow the procedure posted by Crocuta and the advise of critterlover
They have the patient lying flat and head lower to fill the subclavin vein to place the line easier similar to why we put tourniquets on patients starting IVs.
- 0Jul 23, '06 by mach1of8Quote from jmgrn65I assume you are stating this above because you don't think the laying flat head below the heart is to prevent air embolism, right? So just so we all are clear on "your" expert position on this subject, you are stating that air embolisms are not a threat during insertion or removal of central lines, so position and techniques don't matter. If so, you might want to enter "air embolism" search in some major online sites like: Critical Care Magazine, Journal of Intensive Care, New England Journal of Medicine, Annals of Internal medicine, JAMA, chest journal, Journal of Vascular intervention and LWW.com . You would find many articles to the contrary, and documented cases of injury and death from air embolisms.They have the patient lying flat and head lower to fill the subclavin vein to place the line easier similar to why we put tourniquets on patients starting IVs.