Important:  Use a full sterile technique.
DO NOT ATTEMPT THIS PROCEDURE THROUGH THE PORTHOLES

• For longlines inserted via the leg, measure from insertion site to xiphisternum.

• For longlines inserted via the arm, measure from insertion site to the sternal notch.

• Open longline
   pack onto trolley and add:
  • 20 gauge cannula
  • Longline
     set
  • Scalpel blade
  • 5ml syringe
  • 0.9% NaCl 5ml ampoule
  • Heparinised saline 10 unit/ml
  • Skin disinfectant
  • Steristrips
  • Duoderm dressing
  • Tegaderm or Opsite dressing

• Don mask, gown, and gloves.
• Flush the longline
   with 0.9% NaCl leaving syringe attached
• Cut round the IV cannula at the hub leaving cannula on the introducer
• Position the infant maximising access i.e. open the incubator door, slide tray out and use overhead heater. Secure limbs if necessary

• If an assistant is required they must wear a gown and sterile gloves
• Clean the skin with the disinfectant appropriate for the infant’s gestation and age.
  • Wait about 1 minute until it dries otherwise it will not be an effective skin prep.

• Create a sterile field with sterile guards
• Apply tourniquet above site

• Position line, syringe and forceps on sterile field
• Insert cannula, advance cannula off the introducer and withdraw introducer
• Insert longline
   with forceps and feed to premeasured distance releasing tourniquet when catheter is through the cannula
• Withdraw cannula over the longline ensuring the longline is stable by using pressure on the limb above the cannula
• Detach longline at blue connection, remove cannula and reattach connection, ensuring air is not introduced. The black marker that lies over the metal insert must not be visible.
• Flush longline with 0.5ml of heparinised saline (10U/ml)

• Coil longline next to site without crossing longline.
  • Steristrips should be used to anchor the line preventing inward movement and may also help to keep the longline coiled.
• Place a small piece of Duoderm on skin under connection and secure everything with Tegaderm.

• Wrap syringe in sterile guard until position confirmed by x-ray
  • The Department of Health (UK) recommended that the line tip is placed OUTSIDE the heart (Wariyar UK, Hallworth D.  Review of four neonatal deaths due to cardiac tamponade associated with the presence of a central venous catheter.  London, UK: Department of Health; 2001)
• X-ray with contrast medium prior to connecting fluids. This must be done using sterile technique.
• Record in the clinical notes the date, insertion site and length of catheter.  Enter the procedure in the neonatal database.
  • It is also important that we note the catheter tip position in the clinical record.
• If the longline is clearly well into the heart (particularly if it is curled) and needs to be withdrawn, another radiograph must be taken after manipulation to ensure that it has been withdrawn far enough and is in an acceptable position.