POV Pediatric Central Line Placement

Описание: This video is a demonstration of the microskills involved in pediatric central line placement. It does not depict full sterile barrier technique, which is required for non-emergent central lines. Sterile gloves are also not used in this demonstration, but are required. The line would also need to be sutured and dressed.

Note that a pediatric central vein would be more superficial that our ballistics gel model, so the incision would not be as deep.

Syringe manipulation: Negative pressure on plunger while advancing syringe and needle. Plunger head between IF and MF, thumb on flange of syringe. Like a pencil grip. Practice pulling plunger back all the way by running IF along length of your thumb.
Needle stabilization: left hand like it’s holding a pool cue, with a wide base stabilized on the patient’s body
Syringe disconnect: twisting motion without moving the needle
Wire manipulation: slide wire into needle and vein using alternating grasp and release
Skin incision: with blunt side of blade on wire, wiggle the wire to assure that you have no skin bridge
Dilator loading: rest the end of the guidewire on a fingertip (RF) to stabilize along one plane
Dilation: left hand holds wire and provides counter-tension on skin, dilator is advanced through skin in twisting motion, grasp body of dilator (not the hub)
Line placement over wire: stabilize wire on fingertip, skin counter-tension
Wire removal: slide wire out of vein and needle by alternating grasp and release backwards, may slide wire back onto sheath for easier disposal
Catheter flush: lure lock caps on catheter hubs, syringe held vertical, aspirate air bubbles first, then flush line
Line securing: suture and cover