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Task (Internal Jugular Central Line Placement)

CC

Done correctly

Not Done or Done Incorrectly

Informed consent obtained including: risks, benefits and opportunity for questions

C

 

 

Patient placed in Trendelenburg

PC

 

 

Flush the ports with sterile saline

PC

 

 

Clamp each port (ok to keep brown port open)

PC

 

 

Remove cap from brown port to accommodate wire

PC

 

 

Area cleaned with chlorhexadine

PC

 

 

Resident gets in sterile gown, gloves, hat and mask

PC

 

 

Time-out performed

PC

 

 

Area is draped with full body drape

PC

 

 

US probe set up with sterile sheath and gel

PC

 

 

The vein is localized using anatomical landmarks and the US machine

PC

 

 

The skin is anesthetized with 1% lidocaine in a wheal

PC

 

 

The vein is cannulated with the large needle while aspirating under US guidance

PC

 

 

Remove the syringe from the needle

PC

 

 

Advance the guidewire 12-15 cm

PC

 

 

Confirm venous placement using US

PC

 

 

Knick the skin with the scalpel to advance the dilator

PC

 

 

Advance the dilator over the guidewire

PC

 

 

Advance the triple lumen over the guidewire

PC

 

 

Never let go of the guidewire

PC

 

 

Once the catheter is inserted remove the guidewire

PC

 

 

Advance the catheter to approx 14-16 cm on the right side and 16-18 cm on the left side

PC

 

 

Ensure there is blood flow / flush each port

PC

 

 

Place biopatch

PC

 

 

Secure the catheter in place (suture or staple)

PC

 

 

Place dressing over catheter

PC

 

 

Order a CXR

PC

 

 

Maintain sterile technique throughout

PC

 

 

Dispose of all sharps in appropriate container

P

 

 

Complete CLIP form

P

 

 

Name ____________________________________________ Specialty _____________________________

Level of Training _______________________________  Date __________________________________

Modified from:

Barsuk et al. Use of Simulation-Based Mastery Learning to Improve the Quality of Central Venous Catheter Placement in a Medical Intensive Care Unit. Journal of Hospital Medicine . 2009;4:397-403.

 

How many central lines has this resident placed previously?

 

____ femoral  ____IJ  ____subclavian

 

 

This resident appears capable of placing an ultrasound guided internal jugular central line in a patient with normal anatomic landmarks.

 

Strongly disagree       Strongly agree

 

1         2        3    4 5

 

 

This resident needs remediation

 

____ yes

 

____ no

 

 

If yes, the following needs to be improved:

 

 

Other comments:

 

 

This evaluation was discussed with the resident

 

____ yes

 

____ no

 

 

 

Resident Signature: ____________________________________________________________________

 

Facilitator Signature: ___________________________________________________________________