Central Line Set Up

[cfdavid]

So, we use the Arrow brand at our hospital. We place (as I'm sure you do as well) stop-cocks at the end of the colored catheter connectors (brown, blue, white etc.).

When I'm doing Central Lines (still acquiring technique etc.) I seem to "like" to forget to properly flush the stop-cocks with their little three-way valves etc.

Anyone have any videos they could link? Or, any advice with regards to when to put the stop-cocks on (clearly you can't do this on the brown port until you pass the guide wire through, so it needs to be after that (which you've already pulled back on and flushed, then clamped off again.) Also, what is the "best" way to flush the stop-cocks once connected?

I know it's "minor" but it is important, as I'm sure you'll agree, for keeping air out of that thing.

What I've done in the past when not certain that I've properly flushed is just to keep the triple/double lumen lines clamped (again, already flushed) connected the NON-FLUSHED stop-cocks, and then just let the nurse do it. But, I'm interested in having a technique/system for that as it's most helpful to hand them the complete "set", I think.

Any input is appreciated.

cf

---

Members don't see this ad.

 

[Idiopathic]

So, we use the Arrow brand at our hospital. We place (as I'm sure you do as well) stop-cocks at the end of the colored catheter connectors (brown, blue, white etc.).

When I'm doing Central Lines (still acquiring technique etc.) I seem to "like" to forget to properly flush the stop-cocks with their little three-way valves etc.

Anyone have any videos they could link? Or, any advice with regards to when to put the stop-cocks on (clearly you can't do this on the brown port until you pass the guide wire through, so it needs to be after that (which you've already pulled back on and flushed, then clamped off again.) Also, what is the "best" way to flush the stop-cocks once connected?

I know it's "minor" but it is important, as I'm sure you'll agree, for keeping air out of that thing.

What I've done in the past when not certain that I've properly flushed is just to keep the triple/double lumen lines clamped (again, already flushed) connected the NON-FLUSHED stop-cocks, and then just let the nurse do it. But, I'm interested in having a technique/system for that as it's most helpful to hand them the complete "set", I think.

Any input is appreciated.

cf

thats how it starts...next thing you know they will be petitioning to do central lines without your supervision 😉

 

[Idiopathic]

seriously though, this is very minor. some people flush the stopcocks while they are setting up for the line, some kits have individual flush syringes which i would hook up to each clave/stopcock and flush and then just use that to attach to the line. ultimately just keep the ports clamped until the line is secured and then take an extra 30 seconds to flush each one.

also, this is a fairly insignificant issue, as so much air enters the venous circulation in the average patients.

 

[periopdoc]

If at any point in placing a central line, you realize that you failed/ forgot to de-air a part of the system, the absolute worst thing that you can do is ask/ leave it to someone else to sort out. Either the air is too small a volume to be consequential, in which case you ignore it and treat it like any other line, or you decide that it is consequential and deal with it yourself.

My technique for placing central lines is to place it, suture it in, then suck blood back from each port and then flush them. This gives me a double check that the lumens are air free. A my previous institution, the techs and nurses were responsible for getting the central line equipment set up, flushed etc, so I started doing this to double check on them without insulting them by re-flushing the lines that they setup. Trust but verify.

The volume of air in a stopcock is inconsequential in an adult who has no right to left shunt.

- pod

 

[proman]

I do what POD does but will flush before sewing in. I've had a lumen clot off once from drawing back but not flushing. It was annoying.

 

[pgg]

Like POD I aspirate blood then flush and clamp all 3 at the end after suture & dressing. Whether you flush before or after or not at all isn't such a big deal, so long as the lines aren't open to air. But it strikes me as sloppy to not flush them at all, even though the volume of air in the stopcock & 20 cm of 18g lumen is not a big deal for shunt-less hearts.

 

[cfdavid]

Thanks for the feedback guys. I think I'll flush the stopcocks during my second flush. After connecting them, a little "quicky" flush so to speak.

I've been flushing each lumen separately and THEN suturing, but maybe it would be easier to flush AFTER suturing. I'll see if others do it this way at my place.

 

[proman]

What's the second flush? I don't preflush the lines just clamp them.

Stick
Wire
Catheter
Attach claves/stopcocks/whatever/draw back and flush
Suture.

 

[Mman]

What's the second flush? I don't preflush the lines just clamp them.

Stick
Wire
Catheter
Attach claves/stopcocks/whatever/draw back and flush
Suture.

agreed. I clamp everything that won't have the wire coming through it before threading it over the wire. Once it's in, aspirate and flush everything. If I plan on using the stopcock, I just connect it first and then aspirate and flush through it.

 

[BobBarker]

I flush the extra ports first thing and clamp them. Before suturing, I aspirate and flush the brown port. I just leave the other ports clamped.

 

[cchoukal]

I'm with Pro. Sometimes I flush the non-wired ports, but not routinely. I always flush before sewing because there's always a chance the line isn't where you think it is, and there's no point in sewing in a line that isn't in a vein.

 

[jennyboo]

You'll never forget to flush 'em if you 1) don't pre-flush, and 2) at the end, draw back blood into your flush syringe and then just flush through them.

You wouldn't suture in and leave a fully empty unflushed CVC so when you fill up the CVC by aspirating you can also fill up the stopcocks/ports at the same time. Saves time and makes it easier.

I don't leave any catheter with air in it for a nurse to flush.

 

[drccw]

The only time I flush a line before putting it in is if I am putting a central line in an awake patient... if they are under positive pressure ventilation, then I will
- stick
- wire
- cut/dilate
- line
- aspirate/flush
- sew.

I hate hate hate putting lines in awake patients...
cramps my style

drccw