ࡱ> tvs bjbjBrBr 4   ( ( kkkkk8,K$oooooJJJ#######$9&(z#kJJJJJ#kkoo$RRRJkoko#RJ#RR:~",#oа6j" #$0K$"RU)6U)#U)k#JJRJJJJJ##RJJJK$JJJJU)JJJJJJJJJ( 1: Central Line Insertion Care Team Checklist Patient Name: ______________________________ Hx#:____________ Unit: ____________ Date/Time:____________ A minimum of 5 supervised successful procedures in both the chest and femoral sites is required (10 total). If a physician successfully performs 5 supervised lines in one site, he or she is independent for that site only. A total of 3 supervised rewires is required prior to performing a rewire independently. Supervisor Role: 2nd year resident and above (approved for line placement). Assistant Role: RN, ClinTech, MD, NP, PA (responsible for completing checklist). If there is a deviation in any of the critical steps, immediately notify the operator and stop the procedure. If a correction is required, make a check mark in the Yes With Reminder column and note the correction in the comment space. Report uncorrected deviations and complications of line placement. Contact the attending if any item on the checklist is not adhered to or if there are any concerns. Return this completed form to the designated person in your area. Critical StepsYesYes With ReminderProcedure Deviation: Complete ReportCommentsBefore the procedure, did the operatorObtain informed consentObtain supervision if needed (see roles, above)Perform a time-out/briefingConfirm hand washing/sanitizing immediately priorUse full-barrier precautions Operator(s): Cap, mask, sterile gown and gloves, eye protectionSupervisor: Cap, mask, sterile gown and gloves, eye protectionAssistant: Cap, mask, isolation gown and gloves, eye protection (if at risk for entering sterile field, use sterile gown and gloves)Properly position to prevent air embolism For chest/EJ: Trendelenburg (HOB<0 degrees) For femoral: supineSterilize procedure site (chlorhexidine)Allow site to dryUse sterile technique to drape patient from head to toeUse local anesthetic and/or sedationDuring the procedure, did the operatorMaintain a sterile fieldMonitor that lumens were not cutClamp any ports not used during insertion (to avoid air embolism, clamp all but distal port)Obtain qualified second operator after 3 unsuccessful sticks (except if emergent)Aspirate blood from each lumen (to avoid air embolism and ensure intravascular placement)Transduce central venous pressure or estimate central venous pressure by fluid column (to avoid arterial placement)After the procedure, did the operatorClean blood from the site using antiseptic agent (chlorhexidine) and apply sterile dressingVerify placement by x-ray (tip in SVC/RA junction) Operator: ________________________ Supervisor: ________________________ Assistant: ________________________     +89DGKNRUnopr ) R m g h   0 4 U ]   ; 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