Catheter Insertion

B6 Registrar/house officer to contact Interventional Radiology on ext. 81417 or 81082. All requisitions must be discussed either in person or by phone, to avoid delays. Fax the request to 81817. If you cannot contact Interventional Radiology on this number, phone 81410 or 80770 and they will put you through to the appropriate person. (If Interventional Radiology is unable to insert line, call ICU Consultant.)

Platelets should be > 20 x 10⁹/L prior to Hickman insertion. If platelet count is below this, platelets should be given before the procedure with a post platelet count taken. If post platelet count remains below 20 x 10⁹/L, consider giving further platelets.

A record of the procedure is completed by the Interventional Radiology staff using the adult CVAD Insertion Record (C240189).


About this Canterbury DHB document (5037):
Document Owner:	Sean Macpherson (see Who's Who)
Last Reviewed:	January 2019
Next Review:	January 2022
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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Required:	Consent form (to be done by Interventional Radiology staff) Radiology Interventional Pre-Procedure Checklist - C270007 Free fluid 4 hours prior IV fluids pre-insertion: 0.9S 1L over one hour if oral intake <1 litre in last 4 hours Ensure all chest hair is clipped
Additional equipment to go to IR	Hickman catheter sand bag Tegaderm CHG dressing securement device positive displacement devices completed Radiology Interventional Pre-Procedure Checklist – C270007
Cultures	All patients to be nasally swabbed for Staph aureus before line insertion. This is in addition to MRSA swabs if also required. If positive, treat with mupirocin 2% ointment and Chlorhexidine sponges for seven days.
Skin prep (B6)	Chlorhexidine scrubs: half chlorhexidine sponge on 2 occasions, 2 days prior to insertion. (If insufficient time, give second scrub post insertion with shower.)
Premedication	Not routinely given. Consider lorazepam 1-2 mg PO if patient is anxious, however reassurance and education usually helps.
Transport:	X-ray - will send trolley to B6. ICU - BMT staff to arrange for Phillips trolley and orderly.
Skin prep (in X-ray/ICU):	Wash with chlorhexidine 2%.
Insertion site preferred:	Right side of chest.
Sutures:	Exit side - lattice braid around catheter, or else secure sutures.
Type/size of catheter:	Adult Hickman© catheter 10/12.5 French double/triple lumen. Triple lumen preferred for allogeneic haematopoietic stem cell transplants. Catheters are kept in the treatment room of B6.
Weight to site post insertion:	Sandbag for one hour post insertion. X-ray will send patient back to B6 with bag in situ.
X-ray position of catheter:	This is done by radiology before returning patient to B6.