Standards Procedure (Skill)
Clinical Indications: Level: EMT-P only
Ø Central venous access in a patient with an urgent need for fluid or medication administration.
Ø Inability to obtain adequate peripheral access.
Ø Patient aged great than 16 years of age.
Ø No evidence of pelvic trauma.
Ø No evidence of trauma in the extremity in which the catheter is to be placed.
Procedure:
a. Obtain central access kit with a 6.0 to 8.0 French cordis and equipment to place catheter by Selinger technique.
b. Completely expose the groin area on the side where the catheter is to be placed.
c. Palpate the femoral pulse in the inguinal crease. Recall that the inguinal ligament connects the pubic symphysis with the anterior and superior iliac spine and that all attempts to access should be made inferior to this ligament to avoid from entering the abdominal cavity.
d. Once the femoral pulse has been palpated distal to the ilio-inguinal, prep a large area of the skin with Betadine.
e. Use sterile gloves and place sterile drapes around the Betadine prepped field.
f. With one hand palpate the femoral pulse. The femoral vein will be located medially when compared with the femoral artery.
g. With the induction needle from the kit, enter the skin over the anticipated position of the femoral vein. Gently aspirate as the needle is advanced. Angle the needle approximately 45° to 60° in reference to the skin on the thigh.
h. Once non-pulsitile, venous blood is obtained stop advancing the needle and hold the needle in position. Remove the needle and observe for pulsating blood flow. If the blood appears to be arterial in nature or pulsating blood is noted, immediately remove the needle and apply direct pressure over the insertion site. Once the bleeding is controlled. Return to the previous step or consider the other extremity, if there are no contraindications.
i. If the needle appears to be in the femoral vein, insert the guide wire with a sterile technique. Stop advancing the needle if any resistance is met; you may gently withdraw the needle and reattempt insertion if sterility is maintained.
j. Advance the wire until there is approximately 10 cm still left externally to the hub.
k. DO NOT LET GO OF THE WIRE.
l. Holding the wire in the distal hand, remove the needle over the wire. Once the needle reaches the end of the wire, use the proximal hand to control the wire and the distal hand to remove the needle from the wire.
m. Use the scalpel to create a small incision in the skin at the base of the wire. Make certain the incision extends completely to the wire so there is no skin tag.
n. Place the catheter over the wire; use the wire as a guide to place the catheter. Some gentle force may be required as the catheter enters the skin, this should not however, require excessive force. Again, one hand should always maintain control of the wire.
o. Once the catheter is completely inserted, remove the wire.
p. Attach a syringe to the port of the catheter, release the clamp, and aspirate for blood. There should be an easy flow of venous blood.
q. Once all the air has been removed from the catheter through aspiration of blood, re-clamp the line.
r. Attach the desired IV fluid, blood, etc. and begin infusion. Note that “wide-open” lines will deliver large amounts of fluid quickly, monitor the patient’s fluid status closely.
s. Secure the catheter with sterile dressing or sutures.
t. Document the procedure, time, complications, and clinical results on the ACR.
Certification Requirements:
Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure.