Central line insertion

Yes! for best practice another licensed person should have been in the room. This person should have documented training on file verifying that they are capable of verifying that maximal barrier precautions have been followed and are educated on central line insertion procedures. A CLIP (central line insertion procedure) form should then be filled out that confirms that the 5 key aspects of max barrier have been followed. This individual is an empowered observer that has the authority to STOP the procedure if a break in technique should occur so corrective action can be taken. Are you in the US? I can tell you where these guidelines come from if you are interested. IT is also a good idea to have someone in the room to assist with the actual insertion,comfort the patient if needed and be present in case a complication occurs!

Would have been a good idea to have another person in the room, but not a necessity. Having another person who can get things when needed, or help if things go wrong would be very beneficial. It's hard to to set up by yourself and to maintain aseptic tech by yourself.

As to being required. well the depends. There may be a hospital policy that spells out who should be in the room, but there is no law, or anything else that mandates. The last couple of hospitals I worked at didn't specific the number of people who needed to be present. A health tach could be the other person.

The above poster is talking about her hospitals implementation of the central line infection policy. This came out of the work from Dr Peter Pronovost at Johns Hopkins. It's the ideal, and by following this concept hospitals have been able to decrease their catheter related infections. One of the consistent things among the different implementation is a QI tool that collects data on the insertion. Documents content, tech, aseptic tech, etc.

Check out your hospitals policy and if you don't have one, take the bull by the horns and get one started.

When I did MICU, I was always present in the room during a central line or A-line insertion. We had an electronic checklist to complete (it was a CLABSI prevention initiative) and were also there to act as "circulator." As far as it being in "the rules," good question.

Where I work, the resident is responsible for finding an observer; usually it's another resident. If they can't, I'll stick close to help position the sterile field, pouring sterile NS into the tray, and with thd u/s probe cover... but I don't completely interrupt my own nursing duties. If my other pt needs something I go to my other pt.

That would be the day that I would let *any* provider, resident or advanced practice provider, carry out an invasive procedure on one of my patients without my presence at the bedside!!!

What about sterile technique?! What about maximal barriers? What about attending to the patient during a procedure that carries the potential for injury (dropped lung), discomfort (numbing injection, covered with sterile drapes), etc and so on.

Talk about depersonalizing the patient. Talk about trusting a resident to know what s/he is doing!!? Geeze.

Where I work, it's not strictly required. I'm always there at the outset but if the patient is alert, oriented, and cooperative - and the doc has everything they need, I don't just stand there waiting. That's not a value-added expenditure of time.

We place central lines in the OR in children or sometimes in the ICU on sedated children so in those cases, someone else is always in the room. PICCs are placed by the IV RN without anyone else in the room for patients who do it awake or with just oral ativan.

You are under-estimating your value-added nursing presence for the patient.