Procedure Skills and ACLS Refresher

Central Line placement - see photos with step-by-step instructions. You can also check out the videos and PowerPoint files from the Northwestern University, Division of Emergency Medicine. Another free movie is the NEJM central line placement video.

Central lines can be placed with ultrasound guidance. The procedure is illustrated in Central Line Placement with Ultrasound Guidance - Procedure Guide (full version and short version).

Arterial line placement - don't forget the Allen test. There is a new integrated all-in-one arterial line system in the units. This A-line is much simpler and easier to use, in fact, it is used almost exclusively by the SVCH anesthesiologists.


A-line: old is on top, new at the bottom (click to enlarge)

Thoracentesis - step-by-step photos with instructions.

More resources:
Northwestern University website is probably one of the best procedure teaching websites we have found. There is a whole program teaching essential procedures like central lines, thoracostomy, intubation, etc. You can watch them as PowerPoint slides or as streaming videos.
And this is not all. There is a section about suturing and another one is focused on ACLS.

The University of British Columbia website offers an ACLS lecture as a QuickTime movie. A good number of their medical rounds can be watched online, just choose a topic.

Practical Procedures - a complete guide

UCSF Hospitalist Handbook - Procedures

Don't forget the Site Rite U/S system - it's working everytime and looks like a videogame if you ask Basel. Check out our special section about U/S guided TLC placement.


Procedure Notes

A procedure note should be written in the chart when a procedure is performed.
There are sample procedure notes below:

Procedure Note: Central Line
Date and time:
Procedure:
Indications:
Patient Consent:
Lab tests: INR and CBC.
Patient’s right / left ________ was prepped and draped in usual sterile fashion. 2% Lidocaine was used to anesthetize the area. A Triple lumen central line was introduced over a wire via the Seldinger technique and the catheter sutured into place. Good blood flow was noted from the port(s). Blood loss was minimal and the patient tolerated the procedure well without complications. Chest xray was ordered to assess for pneumothorax and catheter placement.


Procedure Note: Arterial Line Placement
Date and time:
Procedure:
Indications:
Patient Consent:
Lab tests: INR and CBC.
Allen’s test performed to ensure adequate perfusion. Patient’s right / left
arm / groin prepped and draped in usual sterile fashion. 1 / 2 % Lidocaine was (not) used to anesthetize the area. An 20g Arrow arterial line was introduced into the radial / femoral artery. Catheter threaded and the needle was removed with appropriate blood return. Blood loss was minimal. Patient tolerated the procedure well, and there were no complications.

Source: University of Michigan

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