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Setting up to introduce a subclavian IV line
Collect all the necessary equipment for the insertion of the central IV catheter:
- three sterile sheets
- sterile surgical blouse (they are also available in paper form for one use)
- antiseptic solution
- sterile surgical gloves
- sterile gauze
- surgical stitch (e.g. 2,0 silk) or two clear see through adhesive tegaderm
- surgical set
- surgical blade
- 2% lidocaine anesthetic solution
- syringes
- test tubes for blood collection (if required)
- normal saline infusion ready, 3-way stop cock and extension line
- subclavian catheter (in the description that follows, an Arrow catheter is being used).
- for safety reasons you can have in close reach a chest drainage system (Bilaw), as well as colloid IV solution (Gelofusin).
If the patient is able to communicate, explain in detail what will follow, making sure that you encourage him and you help reduce their anxiety.
Completely undress the patient above the waist. Place some absorptive under sheets below the patient’s chest, to avoid soiling the bed linen with the antiseptic you will be using plenty of.
Carefully disinfect the wider area of the chest wall, including the area below the lower jaw, the neck, the shoulder and scapula.
Lay out your surgical sterile field on a table near the patient. Place on the sterile field 1-2 syringes, sterile gauze, and surgical blade.
Remove the pillows and place the patient in an upright position.
If the bed is not a mechanical one, elevate the patient’s legs above the
level of the body, by using pillows. This positioning increases pressure
in the subclavian vein and helps in the successful outcome of the catheterization.
The patient’s head must be slightly turned to the left. Get an assistant to hold them. Otherwise you can use an adhesive epidermal tape. One end of the tape is placed on the temple ipsilateral to the side you will be catheterizing and the other, to the opposite side of the mattress.
Lay out a sterile surgical field below the clavicle and a second one above the clavicle, covering the shoulder and partially the head, taking care not to restrict patient’s breathing.
Put on a sterile surgical blouse and gloves.
Ask your assistant to open up the catheter set. Carefully take all the parts and place them onto the table that you have set out with sterile materials.
Ask your assistant to pass the anesthetic solution, from which you will
aspirate 5-8ml. Change the needle.
Inject local anesthetic around the midclavicular area, the skin and the
subcutaneous tissues.