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CENTRAL LINESCENTRAL LINES
ANDAND
ARTERIAL LINESARTERIAL LINES
SHARON HARVEYSHARON HARVEY
26/01/0426/01/04
LEARNING OUTCOMESLEARNING OUTCOMES
THE STUDENT SHOULD BE ABLETHE STUDENT SHOULD BE ABLE
TO:-TO:- IDENTIFY A CENTRAL LINE ANDIDENTIFY A CENTRAL LINE AND
ARTERIAL LINEARTERIAL LINE
 DISCUSS THE INDICATIONS FORDISCUSS THE INDICATIONS FOR
CENTRAL LINES AND ARTERIAL LINESCENTRAL LINES AND ARTERIAL LINES
 DISCUSS THE COMPLICATIONSDISCUSS THE COMPLICATIONS
ASSOCIATED WITH CENTRAL LINESASSOCIATED WITH CENTRAL LINES
AND ARTERIAL LINESAND ARTERIAL LINES
 ARTICULATE THE MANAGEMENT OF AARTICULATE THE MANAGEMENT OF A
PATIENT WITH A CENTRAL LINEPATIENT WITH A CENTRAL LINE
AND/OR ARTERIAL LINEAND/OR ARTERIAL LINE
WHAT IS A CENTRAL LINEWHAT IS A CENTRAL LINE
 It is a catheter thatIt is a catheter that
provides venousprovides venous
access via theaccess via the
superior vena cava orsuperior vena cava or
right atriumright atrium
COMMON CENTRAL LINECOMMON CENTRAL LINE
INSERTION SITESINSERTION SITES
 Right internal jugularRight internal jugular
 left internal jugularleft internal jugular
 right subclavianright subclavian
 left subclavianleft subclavian
 femoral (as a lastfemoral (as a last
resort)resort)
 Or peripherallyOr peripherally
inserted centralinserted central
catheters (PICC)catheters (PICC)
which are inserted viawhich are inserted via
the antecubital veinsthe antecubital veins
(basilic vein is the(basilic vein is the
best) in the arm andbest) in the arm and
is advanced into theis advanced into the
central veinscentral veins
TYPES OF CENTRAL LINETYPES OF CENTRAL LINE
 SINGLE LUMENSINGLE LUMEN
 TRIPLE LUMENTRIPLE LUMEN
 QUADRUPLEQUADRUPLE
LUMENLUMEN
 QUINTUPLE LUMENQUINTUPLE LUMEN
CENTRAL LINESCENTRAL LINES
 Indications for CVP lines are:-Indications for CVP lines are:-
 fluid resuscitationfluid resuscitation
 Parenteral feedingParenteral feeding
 measurement of central venous pressuremeasurement of central venous pressure
 poor venous accesspoor venous access
 administration of irritant drugsadministration of irritant drugs
COMPLICATIONSCOMPLICATIONS
FOLLOWING CVP LINEFOLLOWING CVP LINE
INSERTIONINSERTION
 Malposition of theMalposition of the
cathetercatheter
 haematomahaematoma
 arterial puncturearterial puncture
 pneumothoraxpneumothorax
 haemorrhagehaemorrhage
 sepsissepsis
 air emboliair emboli
 Catheter embolismCatheter embolism
 ThrombosisThrombosis
 HaemothoraxHaemothorax
 Cardiac tamponadeCardiac tamponade
 Cardiac arrhythmiasCardiac arrhythmias
CENTRAL VENOUSCENTRAL VENOUS
PRESSUREPRESSURE
WHAT IS CENTRAL VENOUSWHAT IS CENTRAL VENOUS
PRESSUREPRESSURE
 IS THE PRESSURE WITHIN THEIS THE PRESSURE WITHIN THE
SUPERIOR VENA CAVA OR THE RIGHTSUPERIOR VENA CAVA OR THE RIGHT
ATRIUMATRIUM
CVP READINGS ARE USED:-CVP READINGS ARE USED:-
 TO SERVE AS A GUIDE TO FLUIDTO SERVE AS A GUIDE TO FLUID
BALANCE IN CRITICALLY ILL PATIENTSBALANCE IN CRITICALLY ILL PATIENTS
 TO ESTIMATE THE CIRCULATINGTO ESTIMATE THE CIRCULATING
BLOOD VOLUMEBLOOD VOLUME
 TO ASSIST IN MONITORINGTO ASSIST IN MONITORING
CIRCULATORY FAILURECIRCULATORY FAILURE
CENTRAL VENOUSCENTRAL VENOUS
PRESSURE MONITORINGPRESSURE MONITORING
 THIS IS A HELPFUL TOOL IN THETHIS IS A HELPFUL TOOL IN THE
ASSESSMENT OF CARDIAC FUNCTION,ASSESSMENT OF CARDIAC FUNCTION,
CIRCULATING BLOOD VOLUME, VASCULARCIRCULATING BLOOD VOLUME, VASCULAR
TONE AND THE PATIENT’S RESPONSE TOTONE AND THE PATIENT’S RESPONSE TO
TREATMENTTREATMENT
 HOWEVER, CVP SHOULD NOT BEHOWEVER, CVP SHOULD NOT BE
INTERPRETED SOLELY BUT ININTERPRETED SOLELY BUT IN
CONJUNCTION WITH OTHER SYSTEMICCONJUNCTION WITH OTHER SYSTEMIC
MEASUREMENTS, AS ISOLATED CVPMEASUREMENTS, AS ISOLATED CVP
MEASUREMENTS CAN BE MISLEADINGMEASUREMENTS CAN BE MISLEADING
METHODS OF CVPMETHODS OF CVP
MONITORINGMONITORING
 There are two methods of CVP monitoringThere are two methods of CVP monitoring
 manometer system:manometer system: enables intermittentenables intermittent
readings and is less accurate than thereadings and is less accurate than the
transducer systemtransducer system
 transducer system:transducer system:enables continuousenables continuous
readings which are displayed on a monitor.readings which are displayed on a monitor.
MONITORING WITHMONITORING WITH
TRANSDUCERSTRANSDUCERS
 Transducers enable the pressure readingsTransducers enable the pressure readings
from invasive monitoring to be displayedfrom invasive monitoring to be displayed
on a monitoron a monitor
 To maintain patency of the cannula a bagTo maintain patency of the cannula a bag
of normal saline or heparinised salineof normal saline or heparinised saline
should be connected to the transducershould be connected to the transducer
tubing and kept under continuoustubing and kept under continuous
pressure of 300mmHg thus facilitating apressure of 300mmHg thus facilitating a
continuous flush of 3mls/hrcontinuous flush of 3mls/hr
PROCEDURE FOR CVP MEASUREMENTPROCEDURE FOR CVP MEASUREMENT
USING A TRANSDUCERUSING A TRANSDUCER
 EXPLAIN THE PROCEDURE TO THE PATIENTEXPLAIN THE PROCEDURE TO THE PATIENT
 ENSURE THE LINE IS PATENTENSURE THE LINE IS PATENT
 POSITION THE PATIENT SUPINE (IF POSSIBLE) ANDPOSITION THE PATIENT SUPINE (IF POSSIBLE) AND
ALIGN THE TRANSDUCER WITH THE MID AXILLAALIGN THE TRANSDUCER WITH THE MID AXILLA
(LEVEL WITH THE RIGHT ATRIUM)(LEVEL WITH THE RIGHT ATRIUM)
 ZERO THE MONITORZERO THE MONITOR
 OBSERVE THE CVP TRACEOBSERVE THE CVP TRACE
 DOCUMENT THE READING AND REPORT ANYDOCUMENT THE READING AND REPORT ANY
CHANGES OR ABNORMALITIESCHANGES OR ABNORMALITIES
THE CVP WAVEFORMTHE CVP WAVEFORM
 The CVP waveform reflects changes inThe CVP waveform reflects changes in
right atrial pressure during the cardiacright atrial pressure during the cardiac
cyclecycle
NORMAL CVPNORMAL CVP
MEASUREMENTSMEASUREMENTS Central venous presure monitoring shouldCentral venous presure monitoring should
normally show measurements as follows:normally show measurements as follows:
 Mid Axilla: 0 - 8 mmHg (Woodrow 2000)Mid Axilla: 0 - 8 mmHg (Woodrow 2000)
 An isolated CVP reading is of limitedAn isolated CVP reading is of limited
value; a trend of readings is much morevalue; a trend of readings is much more
significant and should be viewed insignificant and should be viewed in
conjuncton with other parameters e.g. BPconjuncton with other parameters e.g. BP
and urine output.and urine output.
CENTRAL
VENOUS
PRESSURE
CVP
BLOOD VOLUME
(INCREASED
VENOUS RETURN
RAISES CVP
CARDIAC
COMPETENCE
(REDUCED
VENTRICULAR
FUNCTION
RAISES CVP)
INTRATHORACI
C AND
INTRAPERITON
EAL PRESSURE
(RAISES CVP)
SYSTEMIC
VASCULAR
RESISTENCE
(INCREASED
TONE RAISES
CVP)
MANAGEMENT OF A PATIENTMANAGEMENT OF A PATIENT
WITH A CVP LINEWITH A CVP LINE
 Monitor the patient for signs ofMonitor the patient for signs of
complicationscomplications
 Label CVP lines with drugs/fluids etc.Label CVP lines with drugs/fluids etc.
being infused in order to minimise the riskbeing infused in order to minimise the risk
of accidental bolus injectionof accidental bolus injection
 If not in use, flush the cannula regularly toIf not in use, flush the cannula regularly to
help prevent thrombosis. A 500ml bag ofhelp prevent thrombosis. A 500ml bag of
0.9% normal saline should be maintained0.9% normal saline should be maintained
at a pressure of 300mmHg.at a pressure of 300mmHg.
 Ensure all connections are secure toEnsure all connections are secure to
prevent exsanguination, introduction ofprevent exsanguination, introduction of
infection and air emboliinfection and air emboli
 Observe the insertion site frequently forObserve the insertion site frequently for
signs of infection.signs of infection.
 The length of the indwelling catheterThe length of the indwelling catheter
should be recorded and regularlyshould be recorded and regularly
monitored.monitored.
 CVP lines should be removed whenCVP lines should be removed when
clinically indicatedclinically indicated
REMOVAL OF CENTRAL LINEREMOVAL OF CENTRAL LINE
 THIS IS AN ASEPTIC PROCEDURETHIS IS AN ASEPTIC PROCEDURE
 THE PATIENT SHOULD BE SUPINE WITH HEADTHE PATIENT SHOULD BE SUPINE WITH HEAD
TILTED DOWNTILTED DOWN
 ENSURE NO DRUGS ARE ATTACHED AND RUNNINGENSURE NO DRUGS ARE ATTACHED AND RUNNING
VIA THE CENTRAL LINEVIA THE CENTRAL LINE
 REMOVE DRESSINGREMOVE DRESSING
 CUT THE STITCHESCUT THE STITCHES
 SLOWLY REMOVE THE CATHETERSLOWLY REMOVE THE CATHETER
 IF THERE IS RESISTENCE THEN CALL FORIF THERE IS RESISTENCE THEN CALL FOR
ASSISTANCEASSISTANCE
 APPLY DIGITAL PRESSURE WITH GAUZE UNTILAPPLY DIGITAL PRESSURE WITH GAUZE UNTIL
BLEEDING STOPSBLEEDING STOPS
 DRESS WITH GAUZE AND CLEAR DRESSING EGDRESS WITH GAUZE AND CLEAR DRESSING EG
TEGADERMTEGADERM
ARTERIAL LINESARTERIAL LINES
WHAT IS AN ARTERIAL LINE?WHAT IS AN ARTERIAL LINE?
 AN ARTERIAL LINEAN ARTERIAL LINE
IS A CANNULAIS A CANNULA
USUALLYUSUALLY
POSITIONED IN APOSITIONED IN A
PERIPHERALPERIPHERAL
ARTERYARTERY
 SUCH ASSUCH AS
 Radial arteryRadial artery
 brachial arterybrachial artery
 dorsalis pedis arterydorsalis pedis artery
 femoral arteryfemoral artery
INDICATIONS FOR USINGINDICATIONS FOR USING
ARTERIAL LINEARTERIAL LINE
 Ease of accessEase of access
 ContinuousContinuous
monitoring of arterialmonitoring of arterial
blood pressureblood pressure
 if patient is onif patient is on
intropic drugsintropic drugs
 if patient is onif patient is on
vasoactive drugvasoactive drug
 if patient requiresif patient requires
frequent arterialfrequent arterial
blood samplingblood sampling
COMPLICATIONS ASSOCIATEDCOMPLICATIONS ASSOCIATED
WITH ARTERIAL LINESWITH ARTERIAL LINES
 HYPOVOLAEMIAHYPOVOLAEMIA
 ACCIDENTAL INTR-ARTERIALACCIDENTAL INTR-ARTERIAL
INJECTION OF DRUGSINJECTION OF DRUGS
 LOCAL DAMAGE TO ARTERYLOCAL DAMAGE TO ARTERY
Haemodynamic monitoring
Haemodynamic monitoring
Haemodynamic monitoring
THE ARTERIAL WAVEFORMTHE ARTERIAL WAVEFORM
 The arterial waveformThe arterial waveform
reflects the pressurereflects the pressure
generated in thegenerated in the
arteries followingarteries following
ventricular contractionventricular contraction
and can be describedand can be described
as having:-as having:-
 Anacrotic notchAnacrotic notch
 Peak systolicPeak systolic
pressurepressure
 Dicrotic notchDicrotic notch
 Diastolic pressureDiastolic pressure
REMOVAL OF ARTERIAL LINEREMOVAL OF ARTERIAL LINE
 THIS IS AN ASEPTIC PROCEDURETHIS IS AN ASEPTIC PROCEDURE
 REMEMBER UNIVERSAL PRECAUTIONSREMEMBER UNIVERSAL PRECAUTIONS
 THE PROCEDURE SHOULD BE EXPLAINED TO THETHE PROCEDURE SHOULD BE EXPLAINED TO THE
PATIENTPATIENT
 TAKE DRESSING OFF LINETAKE DRESSING OFF LINE
 REMOVE ARTERIAL LINE ENSURING THAT THEREMOVE ARTERIAL LINE ENSURING THAT THE
ENTRY SITE IS COVERED WITH GAUZEENTRY SITE IS COVERED WITH GAUZE
 APPLY DIGITAL PRESSURE FOR AT LEAST 5APPLY DIGITAL PRESSURE FOR AT LEAST 5
MINUTES TO ENSURE HAEMOSTASISMINUTES TO ENSURE HAEMOSTASIS
 DRESS SITE WITH GAUZE AND MICROPOREDRESS SITE WITH GAUZE AND MICROPORE
 ASSESS THE PERIPHERAL CIRCULATION ASASSESS THE PERIPHERAL CIRCULATION AS
THROMBOSIS CAN OCCUR AFTER REMOVALTHROMBOSIS CAN OCCUR AFTER REMOVAL
QUESTIONS????QUESTIONS????

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Haemodynamic monitoring

  • 1. CENTRAL LINESCENTRAL LINES ANDAND ARTERIAL LINESARTERIAL LINES SHARON HARVEYSHARON HARVEY 26/01/0426/01/04
  • 2. LEARNING OUTCOMESLEARNING OUTCOMES THE STUDENT SHOULD BE ABLETHE STUDENT SHOULD BE ABLE TO:-TO:- IDENTIFY A CENTRAL LINE ANDIDENTIFY A CENTRAL LINE AND ARTERIAL LINEARTERIAL LINE  DISCUSS THE INDICATIONS FORDISCUSS THE INDICATIONS FOR CENTRAL LINES AND ARTERIAL LINESCENTRAL LINES AND ARTERIAL LINES  DISCUSS THE COMPLICATIONSDISCUSS THE COMPLICATIONS ASSOCIATED WITH CENTRAL LINESASSOCIATED WITH CENTRAL LINES AND ARTERIAL LINESAND ARTERIAL LINES  ARTICULATE THE MANAGEMENT OF AARTICULATE THE MANAGEMENT OF A PATIENT WITH A CENTRAL LINEPATIENT WITH A CENTRAL LINE AND/OR ARTERIAL LINEAND/OR ARTERIAL LINE
  • 3. WHAT IS A CENTRAL LINEWHAT IS A CENTRAL LINE  It is a catheter thatIt is a catheter that provides venousprovides venous access via theaccess via the superior vena cava orsuperior vena cava or right atriumright atrium
  • 4. COMMON CENTRAL LINECOMMON CENTRAL LINE INSERTION SITESINSERTION SITES  Right internal jugularRight internal jugular  left internal jugularleft internal jugular  right subclavianright subclavian  left subclavianleft subclavian  femoral (as a lastfemoral (as a last resort)resort)  Or peripherallyOr peripherally inserted centralinserted central catheters (PICC)catheters (PICC) which are inserted viawhich are inserted via the antecubital veinsthe antecubital veins (basilic vein is the(basilic vein is the best) in the arm andbest) in the arm and is advanced into theis advanced into the central veinscentral veins
  • 5. TYPES OF CENTRAL LINETYPES OF CENTRAL LINE  SINGLE LUMENSINGLE LUMEN  TRIPLE LUMENTRIPLE LUMEN  QUADRUPLEQUADRUPLE LUMENLUMEN  QUINTUPLE LUMENQUINTUPLE LUMEN
  • 6. CENTRAL LINESCENTRAL LINES  Indications for CVP lines are:-Indications for CVP lines are:-  fluid resuscitationfluid resuscitation  Parenteral feedingParenteral feeding  measurement of central venous pressuremeasurement of central venous pressure  poor venous accesspoor venous access  administration of irritant drugsadministration of irritant drugs
  • 7. COMPLICATIONSCOMPLICATIONS FOLLOWING CVP LINEFOLLOWING CVP LINE INSERTIONINSERTION  Malposition of theMalposition of the cathetercatheter  haematomahaematoma  arterial puncturearterial puncture  pneumothoraxpneumothorax  haemorrhagehaemorrhage  sepsissepsis  air emboliair emboli  Catheter embolismCatheter embolism  ThrombosisThrombosis  HaemothoraxHaemothorax  Cardiac tamponadeCardiac tamponade  Cardiac arrhythmiasCardiac arrhythmias
  • 9. WHAT IS CENTRAL VENOUSWHAT IS CENTRAL VENOUS PRESSUREPRESSURE  IS THE PRESSURE WITHIN THEIS THE PRESSURE WITHIN THE SUPERIOR VENA CAVA OR THE RIGHTSUPERIOR VENA CAVA OR THE RIGHT ATRIUMATRIUM
  • 10. CVP READINGS ARE USED:-CVP READINGS ARE USED:-  TO SERVE AS A GUIDE TO FLUIDTO SERVE AS A GUIDE TO FLUID BALANCE IN CRITICALLY ILL PATIENTSBALANCE IN CRITICALLY ILL PATIENTS  TO ESTIMATE THE CIRCULATINGTO ESTIMATE THE CIRCULATING BLOOD VOLUMEBLOOD VOLUME  TO ASSIST IN MONITORINGTO ASSIST IN MONITORING CIRCULATORY FAILURECIRCULATORY FAILURE
  • 11. CENTRAL VENOUSCENTRAL VENOUS PRESSURE MONITORINGPRESSURE MONITORING  THIS IS A HELPFUL TOOL IN THETHIS IS A HELPFUL TOOL IN THE ASSESSMENT OF CARDIAC FUNCTION,ASSESSMENT OF CARDIAC FUNCTION, CIRCULATING BLOOD VOLUME, VASCULARCIRCULATING BLOOD VOLUME, VASCULAR TONE AND THE PATIENT’S RESPONSE TOTONE AND THE PATIENT’S RESPONSE TO TREATMENTTREATMENT  HOWEVER, CVP SHOULD NOT BEHOWEVER, CVP SHOULD NOT BE INTERPRETED SOLELY BUT ININTERPRETED SOLELY BUT IN CONJUNCTION WITH OTHER SYSTEMICCONJUNCTION WITH OTHER SYSTEMIC MEASUREMENTS, AS ISOLATED CVPMEASUREMENTS, AS ISOLATED CVP MEASUREMENTS CAN BE MISLEADINGMEASUREMENTS CAN BE MISLEADING
  • 12. METHODS OF CVPMETHODS OF CVP MONITORINGMONITORING  There are two methods of CVP monitoringThere are two methods of CVP monitoring  manometer system:manometer system: enables intermittentenables intermittent readings and is less accurate than thereadings and is less accurate than the transducer systemtransducer system  transducer system:transducer system:enables continuousenables continuous readings which are displayed on a monitor.readings which are displayed on a monitor.
  • 13. MONITORING WITHMONITORING WITH TRANSDUCERSTRANSDUCERS  Transducers enable the pressure readingsTransducers enable the pressure readings from invasive monitoring to be displayedfrom invasive monitoring to be displayed on a monitoron a monitor  To maintain patency of the cannula a bagTo maintain patency of the cannula a bag of normal saline or heparinised salineof normal saline or heparinised saline should be connected to the transducershould be connected to the transducer tubing and kept under continuoustubing and kept under continuous pressure of 300mmHg thus facilitating apressure of 300mmHg thus facilitating a continuous flush of 3mls/hrcontinuous flush of 3mls/hr
  • 14. PROCEDURE FOR CVP MEASUREMENTPROCEDURE FOR CVP MEASUREMENT USING A TRANSDUCERUSING A TRANSDUCER  EXPLAIN THE PROCEDURE TO THE PATIENTEXPLAIN THE PROCEDURE TO THE PATIENT  ENSURE THE LINE IS PATENTENSURE THE LINE IS PATENT  POSITION THE PATIENT SUPINE (IF POSSIBLE) ANDPOSITION THE PATIENT SUPINE (IF POSSIBLE) AND ALIGN THE TRANSDUCER WITH THE MID AXILLAALIGN THE TRANSDUCER WITH THE MID AXILLA (LEVEL WITH THE RIGHT ATRIUM)(LEVEL WITH THE RIGHT ATRIUM)  ZERO THE MONITORZERO THE MONITOR  OBSERVE THE CVP TRACEOBSERVE THE CVP TRACE  DOCUMENT THE READING AND REPORT ANYDOCUMENT THE READING AND REPORT ANY CHANGES OR ABNORMALITIESCHANGES OR ABNORMALITIES
  • 15. THE CVP WAVEFORMTHE CVP WAVEFORM  The CVP waveform reflects changes inThe CVP waveform reflects changes in right atrial pressure during the cardiacright atrial pressure during the cardiac cyclecycle
  • 16. NORMAL CVPNORMAL CVP MEASUREMENTSMEASUREMENTS Central venous presure monitoring shouldCentral venous presure monitoring should normally show measurements as follows:normally show measurements as follows:  Mid Axilla: 0 - 8 mmHg (Woodrow 2000)Mid Axilla: 0 - 8 mmHg (Woodrow 2000)  An isolated CVP reading is of limitedAn isolated CVP reading is of limited value; a trend of readings is much morevalue; a trend of readings is much more significant and should be viewed insignificant and should be viewed in conjuncton with other parameters e.g. BPconjuncton with other parameters e.g. BP and urine output.and urine output.
  • 17. CENTRAL VENOUS PRESSURE CVP BLOOD VOLUME (INCREASED VENOUS RETURN RAISES CVP CARDIAC COMPETENCE (REDUCED VENTRICULAR FUNCTION RAISES CVP) INTRATHORACI C AND INTRAPERITON EAL PRESSURE (RAISES CVP) SYSTEMIC VASCULAR RESISTENCE (INCREASED TONE RAISES CVP)
  • 18. MANAGEMENT OF A PATIENTMANAGEMENT OF A PATIENT WITH A CVP LINEWITH A CVP LINE  Monitor the patient for signs ofMonitor the patient for signs of complicationscomplications  Label CVP lines with drugs/fluids etc.Label CVP lines with drugs/fluids etc. being infused in order to minimise the riskbeing infused in order to minimise the risk of accidental bolus injectionof accidental bolus injection  If not in use, flush the cannula regularly toIf not in use, flush the cannula regularly to help prevent thrombosis. A 500ml bag ofhelp prevent thrombosis. A 500ml bag of 0.9% normal saline should be maintained0.9% normal saline should be maintained at a pressure of 300mmHg.at a pressure of 300mmHg.
  • 19.  Ensure all connections are secure toEnsure all connections are secure to prevent exsanguination, introduction ofprevent exsanguination, introduction of infection and air emboliinfection and air emboli  Observe the insertion site frequently forObserve the insertion site frequently for signs of infection.signs of infection.  The length of the indwelling catheterThe length of the indwelling catheter should be recorded and regularlyshould be recorded and regularly monitored.monitored.  CVP lines should be removed whenCVP lines should be removed when clinically indicatedclinically indicated
  • 20. REMOVAL OF CENTRAL LINEREMOVAL OF CENTRAL LINE  THIS IS AN ASEPTIC PROCEDURETHIS IS AN ASEPTIC PROCEDURE  THE PATIENT SHOULD BE SUPINE WITH HEADTHE PATIENT SHOULD BE SUPINE WITH HEAD TILTED DOWNTILTED DOWN  ENSURE NO DRUGS ARE ATTACHED AND RUNNINGENSURE NO DRUGS ARE ATTACHED AND RUNNING VIA THE CENTRAL LINEVIA THE CENTRAL LINE  REMOVE DRESSINGREMOVE DRESSING  CUT THE STITCHESCUT THE STITCHES  SLOWLY REMOVE THE CATHETERSLOWLY REMOVE THE CATHETER  IF THERE IS RESISTENCE THEN CALL FORIF THERE IS RESISTENCE THEN CALL FOR ASSISTANCEASSISTANCE  APPLY DIGITAL PRESSURE WITH GAUZE UNTILAPPLY DIGITAL PRESSURE WITH GAUZE UNTIL BLEEDING STOPSBLEEDING STOPS  DRESS WITH GAUZE AND CLEAR DRESSING EGDRESS WITH GAUZE AND CLEAR DRESSING EG TEGADERMTEGADERM
  • 22. WHAT IS AN ARTERIAL LINE?WHAT IS AN ARTERIAL LINE?  AN ARTERIAL LINEAN ARTERIAL LINE IS A CANNULAIS A CANNULA USUALLYUSUALLY POSITIONED IN APOSITIONED IN A PERIPHERALPERIPHERAL ARTERYARTERY  SUCH ASSUCH AS  Radial arteryRadial artery  brachial arterybrachial artery  dorsalis pedis arterydorsalis pedis artery  femoral arteryfemoral artery
  • 23. INDICATIONS FOR USINGINDICATIONS FOR USING ARTERIAL LINEARTERIAL LINE  Ease of accessEase of access  ContinuousContinuous monitoring of arterialmonitoring of arterial blood pressureblood pressure  if patient is onif patient is on intropic drugsintropic drugs  if patient is onif patient is on vasoactive drugvasoactive drug  if patient requiresif patient requires frequent arterialfrequent arterial blood samplingblood sampling
  • 24. COMPLICATIONS ASSOCIATEDCOMPLICATIONS ASSOCIATED WITH ARTERIAL LINESWITH ARTERIAL LINES  HYPOVOLAEMIAHYPOVOLAEMIA  ACCIDENTAL INTR-ARTERIALACCIDENTAL INTR-ARTERIAL INJECTION OF DRUGSINJECTION OF DRUGS  LOCAL DAMAGE TO ARTERYLOCAL DAMAGE TO ARTERY
  • 28. THE ARTERIAL WAVEFORMTHE ARTERIAL WAVEFORM  The arterial waveformThe arterial waveform reflects the pressurereflects the pressure generated in thegenerated in the arteries followingarteries following ventricular contractionventricular contraction and can be describedand can be described as having:-as having:-  Anacrotic notchAnacrotic notch  Peak systolicPeak systolic pressurepressure  Dicrotic notchDicrotic notch  Diastolic pressureDiastolic pressure
  • 29. REMOVAL OF ARTERIAL LINEREMOVAL OF ARTERIAL LINE  THIS IS AN ASEPTIC PROCEDURETHIS IS AN ASEPTIC PROCEDURE  REMEMBER UNIVERSAL PRECAUTIONSREMEMBER UNIVERSAL PRECAUTIONS  THE PROCEDURE SHOULD BE EXPLAINED TO THETHE PROCEDURE SHOULD BE EXPLAINED TO THE PATIENTPATIENT  TAKE DRESSING OFF LINETAKE DRESSING OFF LINE  REMOVE ARTERIAL LINE ENSURING THAT THEREMOVE ARTERIAL LINE ENSURING THAT THE ENTRY SITE IS COVERED WITH GAUZEENTRY SITE IS COVERED WITH GAUZE  APPLY DIGITAL PRESSURE FOR AT LEAST 5APPLY DIGITAL PRESSURE FOR AT LEAST 5 MINUTES TO ENSURE HAEMOSTASISMINUTES TO ENSURE HAEMOSTASIS  DRESS SITE WITH GAUZE AND MICROPOREDRESS SITE WITH GAUZE AND MICROPORE  ASSESS THE PERIPHERAL CIRCULATION ASASSESS THE PERIPHERAL CIRCULATION AS THROMBOSIS CAN OCCUR AFTER REMOVALTHROMBOSIS CAN OCCUR AFTER REMOVAL

Notas do Editor

  1. Why would the femoral vein be used as a last resort?
  2. ALWAYS EXPLAIN ANY PROCEDURE TO THE PATIENT HOW DO WE DO THIS? WHY DO WE LIE THE PATIENT SUPINE? OFF TO PATIENT OPEN TO AIR AND PRESS ZERO ON THE MONITOR. THIS REMOVES EXTRANEOUS PRESSURE TO ENSURE A CORRECT TRACE
  3. A wave: right atrial contraction (P wave on the ECG)If the A wave is elevated the patient may have right ventricular failure or tricuspid stenosis. C wave: tricuspid valve closure (follows QRS complex on the ECG). V wave: pressure generated to the right atrium during ventricular contraction, despite the tricuspid valve being closed (latter part of the T wave on the ECG)
  4. Transparent dressings should be used to permit continuous monitoring of the site. If infection of the CVP line is suspected blood cultures should be taken following removal of the line. The catheter tip should be sent for M C & S.
  5. Thereby avoiding the discomfort of frequent punctures of the artery eg tests for blood gases, serial blood lactate levels, full blood count, u&e’s etc.
  6. HYPOVOLAEMIA – ACCIDENTAL DISCONNECTION OF TUBING FROM THE CANNULA CAN RESULT IN SEVERE HAEMORRHAGE AND HYPOVOLAEMIA NO DRUGS SHOULD BE ADMINISTERED THROUGH THE ARTERIAL LINE AS IT CAN CAUSE DISTAL ISCHAEMIA AND NECROSIS WITH SOMETIMES PERMANENT DAMAGE LOCAL DAMAGE TO ARTERY – THIS IS THE MOST COMMON COMPLICATION. IT IS IMPORTANT TO KEEP AN EYE ON THE DISTAL END EG FINGERS WATCH FOR SIGNS OF CHANGE IN TEMPERATURE, MOTTLING OR BLANCHING PARTICULARLY WHEN THE LINE IS FLUSHED.