Triple lumen central line7/27/2023 So plan a little - always save a port - maybe one of the medial ones - on a newly placed central line for TPN (even if the patient isn't on it yet. We also use the distal port for giving blood products, simply because it's big: the distal port is a 16-gauge lumen, while the other two are 18's. We usually hook up the distal port to the transducer for reading CVP's, because the medial and proximal ports can snuggle up to the vessel wall and give weird waveforms. If the patient becomes critical enough, then you can take the TPN down and use the port for something else, but you can't use the port for TPN again - the patient will need a new line. If you use the central line for TPN - which you should! - then that lumen is tied up for good. Make sure that the team has checked: you should never infuse anything through a port that doesn't have a blood return. The medial port is the next one backwards, and the proximal port is the one closest to the skin. So the lumen that opens up at the very tip-end of the catheter - that's the distal port, because it opens the farthest away from the insertion point. In other words, the ports are proximal or distal in relation to the site where the line goes into the patient. The tip should be cut off with sterile scissors and dropped directly into a sterile specimen container.The ports are described as proximal, medial and distal - these are the reverse of proximal and distal as regards the patient. When catheter-related infections are suspected, the catheter tip provides valuable information about infection sources in cases of sepsis. ![]() The site should be carefully inspected for inflammation, and any drainage should be cultured. Maintenance care procedures also should be fully documented. Documentation should include preprocedure and postprocedure physical assessment of the patient, catheter type and size, insertion site location, x-ray confirmation of the placement, catheter insertion distance (in centimeters), and the patient’s tolerance of the procedure. ![]() Health care professionals are responsible for preventing, assessing for, and managing central venous therapy complications (e.g., air embolism cardiac tamponade chylothorax, hemothorax, hydrothorax, or pneumothorax local and systemic infections and thrombosis). ![]() IV tubing and solutions and injection caps also should be changed as required by the agency’s protocol. Dressing changes are carried out using sterile technique. The catheter should be manipulated as infrequently as possible during its use. An antibiotic impregnated patch covered by a sterile dressing should be placed at the insertion site. After the catheter is inserted, it should be firmly sewn to the skin to keep it from migrating in and out of the insertion site. Any clue on what the CPT might be I was thinking 32553 but then I thought not because its for radiation therapy and the pt did not have that. The doctor noted it as a 'central line placement'. ![]() With or without radiological guidance, the best results are obtained by practitioners who perform the procedure frequently. Procedure reads: Placement of left subclavian Cordis catheter with insertion of triple-lumen catheter through the Cordis catheter. Ultrasound guidance improves the likelihood of entering the desired vein without injury to neighboring structures. The skin should be prepared with chlorhexidine-gluconate (2%) or povidone-iodine. Sterile technique is a requirement during insertion. The subclavian approach to the placement of a central line is preferred, because femoral placements may be complicated by deep venous thrombosis, and internal jugular sites carry an increased risk of infection. Health care professionals must use caution to prevent life-threatening complications when inserting and maintaining a central line. A catheter inserted into the superior vena cava to permit intermittent or continuous monitoring of central venous pressure, to administer fluids, medications or nutrition, or to facilitate obtaining blood samples for chemical analysis.
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