Canterbury DHB

Context

Catheter Insertion

BMTU 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.

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 (BMTU)

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 BMTU.

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 BMTU.

Weight to site post insertion:

Sandbag for one hour post insertion.

X-ray will send patient back to BMTU with bag in situ.

X-ray position of catheter:

This is done by radiology before returning patient to BMTU.

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)

Issue Date:

January 2019

Next Review:

January 2022

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5037