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Pre-procedure diagnosis:

- Need for intravenous access


- sepsis
Post-procedure diagnosis:
- Need for intravenous access
- sepsis
Procedure performed: central line placement (Right IJ)
Indications:
- Need for intravenous access
- sepsis
Technique/Procedure:
After consent was obtained, a time-out was completed at the patients bedside. The
patient was placed in the trendelenburg position and a back roll was placed. The
patients right neck was prepped and draped in standard sterile fashion. 5cc of 1%
Lidocaine was infitrated for local anesthesia. Using a ultrasound the carotid artery
was identified, and a compressible lumen just lateral to the artery was seen. Under
ultrasound visualization an 18 gauge need was inserted into the right internal
jugular vein. Return of dark, non-pulsatile blood was observed. A guidewire was
placed through the needle into the vein. A small incision was made with a #10
scalpel and the sheath was exchanged for a dilator over the guidewire until
appropriate dilation was obtained. Using the seldinger technique, a 3Fr 16cm triple
lumen catheter was advanced over the guidewire to the 16cm mark. Blood was
aspirated from all ports and all ports were flushed with 10cc of sterile saline. The
catheter was secured with 2 sutures. A Biopatch and occlusive sterile dressing was
applied. A STAT chest xray for placement was immediately ordered.
OR
Technique/Procedure:
After consent was obtained, a time-out was completed at the patients bedside. The
patients left groin was prepped and draped in standard sterile fashion. 5cc of 1%
Lidocaine was infitrated for local anesthesia. The left femoral artery was palpated,
and an 18 gauge need was inserted just medial to the pulse to cannulate the
femoral vein. Return of dark, non-pulsatile blood was observed. A guidewire was
placed through the needle into the vein. A small incision was made with a #10
scalpel and the sheath was exchanged for a dilator over the guidewire until
appropriate dilation was obtained. Using the seldinger technique, a 3Fr 16cm triple
lumen catheter was advanced over the guidewire. Blood was aspirated from all
ports and all ports were flushed with 10cc of sterile saline. The catheter was
secured with 2 sutures. A Biopatch and occlusive sterile dressing was applied.
Implant(s): 3fr triple lumen catheter
Complications: none
Estimated blood loss in ml's: 5.0
Findings:
catheter placed in right internal jugular vein
return of non-pulsatile, dark blood
all ports aspirated with proper blood return and flushed w/ 10cc of sterile saline
Disposition: tolerated proc. well

Recommendations:
STAT CXR for placement confirmation

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