Procedures
Central venous lines
When you place a central line please consider carefully if blood cultures will be helpful. If you send bloods from a newly placed central line please label these as a peripheral blood culture. This is to avoid confusion about the potential for an infected central line.
If you are inexperienced in the insertion of central venous lines then this is something that we would expect you to be able to learn during your rotation. This will be discussed further in the orientation. Please note that there are expectations regarding the minimum number of central lines that should be placed under supervision prior to independent insertion.
The linked document details our expectations regarding CVL insertion. Please review this prior to placing a central line for the first time in this department. It contains details about what is regarded as a competent trainee and an experienced registrar. For registrars who are not familiar with CVL insertions this also details the minimum number of supervised CVL insertions that are required prior to final assessment and sign off.
CVL Insertion Safety Documentation
The insertion checklist is linked below and may also be found on the lines trolley.
Arterial lines
Please ensure adequate sterility when inserting arterial lines. A variety of cannulae are available as is ultrasound.
Pulmonary artery catheters
Pulmonary artery catheters are used infrequently in DCCM however there are certain patient groups for whom they remain appropriate. If you have not inserted these previously then you will require supervision.
Intercostal drains
Both percutaneous and surgically placed drains are used in DCCM. Ultrasound is available if required. If you are unfamiliar or inexperienced with chest drain insertion then please ensure that you ask for assistance when appropriate.
Please note that chest drains are removed by the medical staff in DCCM. If you have not performed chest drain removal previously then please discuss this with the consultant when required.
Insertion and securing techniques vary and during removal you may need to use a suture. Please ensure that you have one available.
Urinary catheters
Most of the urinary catheters are inserted by the nursing staff. There are occasions when you may be asked to perform this procedure. Please follow usual practice when inserting catheters.