Procedural Skills for Medical Students s1

Procedural Skills for Medical Students

Central Line placement: Internal Jugular (IJ)

Objectives: 1. Learners should be able to verbalize the indications and contraindications of central line placement. 2. Learners should be able to verbalize the ideal anatomical location for placement of an internal jugular line. 3. Learners should be able to insert IJ central line on central line trainer, using sterile technique.

Material to review prior to lab: Video on Central Venous Catheterization and Ultrasound- Guided IJ Cannulation (need access to New England Journal of Medicine, available to students through the University of Arizona Health Sciences Library)

Indications: 1. Venous access in obese or debilitated patients who have peripheral veins that are inaccessible for peripheral IV cannulation. 2. Emergency venous access after a cardiac arrest 3. Administration of cardiac medication during cardiopulmonary resuscitation 4. Large-volume parenteral fluid administration when peripheral IV cannulation is not readily obtainable 5. Central venous pressure monitoring 6. Administration of certain chemotherapeutic agents, vasopressor medications, or hyperosmolar infusions (i.e. total parenteral nutrition) 7. Performance of right cardiac catheterization and pulmonary angiography 8. Performance of hemodialysis or plasmapheresis

Contraindications: 1. Patient refusal 2. Distortion of local anatomy or landmarks 3. Superior vena cava syndrome 4. Uncontrolled coagulopathy 5. Burn or cellulitis over insertion site 6. Venous thrombosis of the proposed site 7. Right-sided endocarditis or mural thrombus Equipment: HPS, central line kit, IJ central line trainer Instructional Procedure & Endpoints: 1. Learners will be oriented to trainer and equipment in ASTEC.

1 Procedural Skills for Medical Students 2. ASTEC staff or facilitator will demonstrate instruction on proper sterile technique for insertion of internal jugular central venous line. 3. Learners will demonstrate one IJ central line insertion on trainer using sterile technique with guidance from ASTEC staff.

References: Graham, A.S., Ozment, C., Tegtmeyer, K., Lai, S., & Braner, D. (2007). Central venous catheterization. The New England Journal of Medicine, 356(e21). Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMvcm055053#figure=preview.gif James, D. (2011). Central venous catheter insertion. In J.L. Pfenninger, & G.C. Fowler (Eds.), Procedures for Primary Care, 3rd Ed (1443-1450). Philadelphia: Elsevier Mosby. Ortega, R., Song, M., Hansen, C.J., & Barash, P. (2010). Ultrasound-guided internal jugular vein cannulation. The New England Journal of Medicine, 362(e57). Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMvcm0810156#figure=preview.jpg