![]() A stool helps to position health care provider into optimal position for pressure application and reduces back strain. Adequate and direct pressure is required to stop bleeding from a central venous or arterial catheter.Īssess patient to determine ability to remain flat during application of pressure and obtain assistant if required for positioning. If removing a femoral venous catheter, obtain a bedside stool. Additional site pressure may be required. The catheter site may also influence bleeding risk. Medications that interfere with clotting should also be reviewed. administration of plasma or platelets) or whether removal should be delayed. If the patient has a significant coagulopathy the removal order should be reviewed to determine whether treatment is warranted (e.g. If patient is receiving any medications that affect coagulation (e.g., anticoagulants, fibrinolytics, antiplatelet agents), review with physician prior to removal. If INR/PTT is prolonged (INR > 1.5) or platelets < 50,000 review orders with physician. ![]() VASCULAR CONSULT SHOULD BE PERFORMED FOR ARTERIAL CANNULATION ONCE THE VESSEL HAS BEEN DILATED.Ĭheck INR/PTT and platelets. ![]() NURSES DO NOT REMOVE A CVC THAT HAS BEEN INADVERTENTLY PLACED INTO AN ARTERY. Perform hand hygiene and don a mask with eye shield and non-sterile gloves prior to blood sampling.Ĭonfirm 2 patient identifiers as per LHSC Policy for Patient Identification This includes tunneled dialysis lines (perm caths).įollow LHSC policies for hand hygiene and infection control before, during and after procedure. Nurses in CCTC are not approved to removed tunneled catheters or implantable ports. Nurses may remove temporary hemodialysis catheters, but should be aware of the large catheter size increases the risk for both bleeding and air embolism. RNs in CCTC may removed temporary central venous access devices including: PICC, Internal Jugular (IJ), Subclavian (SC) and Femoral. Procedure for Removal of Central Venous Catheter (IJ, SC and Femoral) 51(6): 636 – 42.Ensure that patient and health care provider safety standards are met during this procedure including: Safety and Efficacy of the “Easy Internal Jugular (IJ)”: An Approach to Difficult Intravenous Access. Loss of patency, the only complication, occurred in 14% of cases.”Ĭlinical Take Home Point: In stable patients, who have had failed attempts at establishing peripheral or external jugular vein access, the Easy IJ is a rapid method of achieving short-term IV access with no major adverse patient oriented outcomes. The procedure itself takes about 5 minutes which is a significantly shorter time than central line placementĪuthor Conclusion: “The Easy IJ was inserted successfully in 88% of cases, with a mean time of 4.4 min.The authors of the paper state that in the limited literature available on this procedure there are no documented cases of pneumothorax, neck hematoma, inadvertent arterial placement, line infection, or site infection.Unstable patients were excluded in this study, therefore cannot draw conclusions of the Easy IJ in unstable patients.Easy IJ catheters were left in for ≤24hrs in this study, therefore infection risk beyond 24 hours cannot be ascertained from this study.Confidence intervals are wide relative to complication rates for the Easy IJ.Hemodynamic instability (HR >150BPM, or MAP 20 previous ultrasound guided line placements, may reduce generalizability if provider is not well versed with ultrasound.Ability to dilate IJ with Valsalva maneuver.Failed attempts at establishing peripheral or external jugular vein access (Including attempts using ultrasound).Ultrasound machine with high-frequency linear transducer.Easy Internal Jugular (IJ) Access: Placement of an 18 gauge, 4.8 cm, single-lumen catheter (the same catheter used for peripheral access) in the IJ with ultrasound guidance.Multicenter, prospective observational study to evaluate the efficacy and safety of the easy IJ in stable ED patients with difficult intravenous access.The authors of this paper evaluate yet another option: The Easy IJ. Ultrasound guided peripheral IVs and external jugular access would probably be the next “go to options” in these patients. Ultrasound guidance has been a great addition in these patients. ![]() In stable patients, however, this may be a less desirable. Many providers have resorted to using IO access, particularly in critically ill patients due to speed of establishing access. This often creates delays in patient care, increases ED length of stay, and uses up ED staff that have other patients to care for. Background: We have all taken care of patients in whom IV access is difficult due to a multitude of reasons including repeated prior IV access, advanced vascular disease and shock. ![]()
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