Infection rates, catheter dwell times, patient outcomes,

and rates of complications should be monitored (2).

10. Remove catheter as soon as it is no longer medically

necessary by slowly withdrawing it from insertion site.

Clean insertion site with prep prior to withdrawing

catheter. Hold pressure over site if bleeding is a problem. Remove prep from skin. Place a clean gauze dressing over site. Document length removed.

Placement of Central Venous Catheters

by Surgical Cutdown

A. Types of Catheters

Silicone catheters are preferred because they are constructed of relatively inert materials, offer increased pliability, and are associated with lower rates of infection and

thrombosis. These catheters are placed in a central vein,

and the distal end is tunneled subcutaneously a short distance from the access site to an exit wound. The catheters

usually have a single lumen with a Dacron cuff, which

adheres to the subcutaneous tract, anchoring the catheter.

Polyethylene catheters have a higher rate of infection and

thrombolytic complications and are not recommended for

long-term IV access.

B. Contraindications

In addition to the relative contraindications delineated earlier, the internal jugular vein should be avoided if the contralateral jugular vein has been catheterized previously, or if

there is thrombosis of the jugular venous system on the

opposite side.

C. Equipment

Sterile

1. Skin prep: Per institutional policy (e.g., 10% povidone–

iodine, or 0.5% chlorhexidine solution)

2. Gown and gloves

3. Cup with antiseptic solution

4. Sterile transparent aperture drape; four sterile towels to

ensure a sterile operative field

5. Four 4- × 4-inch gauze squares

6. Local anesthetic: 0.5% lidocaine HCl in labeled 3-mL

syringe with 25-gauge venipuncture needle

Consider sedation and pain medication in addition

to local anesthesia. Patients who are intubated may be

given a sedative and muscle relaxant in addition to

local anesthesia. When patients are taken to the operating room, general anesthesia is preferred.

7. Catheter of choice

8. Heparinized 0.25 N saline flush solution (1 U/mL) in

3-mL syringe

9. 4-0 polyglactin suture (Vicryl; Ethicon, Somerville,

New Jersey) and 5-0 nylon suture (black monofilament

nylon) on cutting needles (see Appendix B)

10. T connector connected with a sterile 3-mL syringe

filled with heparinized saline

11. No. 11 scalpel blade and holder

12. Two small tissue retractors or self-retaining retractor

13. Tissue forceps

14. Fine vascular forceps