Central Venous Catheter (Longline) Insertion
|Reviewed Clinical Practice
Selecting a long line:
silicone 24G (2F) single lumen 30cm
This is the preferred line for all infants not requiring a second
lumen (i.e. most of our babies).
Premicath polyurethane 28G (1F) single lumen
This should be used for infants
weighing < 1000 g only when a 24G line is unable to be inserted.
If used for any other indications, please discuss with specialist on
service or on call first.
Maximum flow rate 10ml/hr
Vygon Nutrioline Twinflo polyurethane 23G
(2F) double lumen 30cm:
This line is only to be used for infants requiring a second lumen
(for example, a baby requiring TPN and Prostaglandin infusion).
- Skin sepsis at insertion site
- Bacteraemia or septicaemia
- Large vein in antecubital
fossa, long saphenous vein or posterior tibial vein
Use a full sterile technique.
DO NOT ATTEMPT THIS PROCEDURE
THROUGH THE PORTHOLES
- Open longline
trolley and add:
- 20 gauge cannula
- Scalpel blade
- 5ml syringe NB.
Use only 10 ml syringe for flushing 28G
- 0.9% NaCl 5ml ampoule
- Heparinised saline 10
- Skin disinfectant
- Duoderm dressing
- Tegaderm or Opsite
- Don mask, gown, and
- Flush the longline
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 infantís gestation
- Wait about 1 minute until
it dries otherwise it will not be an effective skin prep.
- Create a sterile field with
- 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
- 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
- Flush longline with 0.5ml of heparinised saline
- 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;
- 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.
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