Central Line -

Subclavian Approach

 

Central Line -

Internal Jugular

with ultrasound

 

Thoracentesis

Paracentesis

 

Arterial Line

 

Lumbar Puncture

knee

arthrocentesis

 

Procedure Tips:

  •   If the patient you wish to perform a procedure on has impaired decision-making ability, the person holding medical power of attorney should give consent.  If the patient does not have a medical power of attorney or they are unavailable, then a surrogate decision-maker must be found. In the state of Arizona, the order of decision-makers is spouse, adult children, parents, siblings, domestic partner and then close friend.  If none can be found, and the procedure is urgent or emergent, a 2-physician consent can be performed. 

  • A "Time Out" is required before all procedures. Performing a “Time out” involves identifying the correct patient with at least 2 identifiers, identifying the correct indicated procedure (including location), confirming correct completed consent, and confirming correct materials immediately prior to beginning.

  • Select the setting for the procedure that optimizes efficiency, safety, and resident education.  Procedures should be performed at bedside whenever possible.

  • Components of a procedure note includes: indication for procedure, informed consent obtained, time out completed, names and functions of each physician involved, supervising physician, pertinent physical findings (i.e., Allen test when performing radial arterial cannulation), anesthetic used, sterile technique and anatomic location of procedure, any specific data obtained (i.e., opening pressure on lumbar puncture), complications, and planned follow-up.