Table 1 Temporary dialysis catheter insertion checklist: percentage of participants who performed each checklist item correctly
ITEM | Pretest (%) n = 22 | Posttest (%) n = 17 |
|---|---|---|
Informed consent obtained | 77.3 | 88.2 |
Benefits (must state 1) | ||
Risks (must state 2) | ||
Consent given | ||
Washes hands | 36.4 | 88.2 |
Places the patient in slight Trendelenburg position | 22.7 | 88.2 |
Tests each port and flushes the lines with sterile saline | 63.6 | 100 |
Clamps each port (may leave distal port open) | 68.2 | 100 |
Area cleaned with chlorhexidine in a back and forth motion for at least 30 seconds | 4.5 | 100 |
Gets in sterile gown, gloves, mask and cap | 81.8 | 100 |
Area draped in usual fashion using full body drape | 50.0 | 100 |
Ultrasound probe is properly set up, draped, and sonographic gel is used | 59.1 | 88.2 |
The vein is localized using anatomical landmarks with the ultrasound machine | 86.4 | 100 |
The skin is anesthetized with 1% lidocaine in a small wheal | 81.8 | 100 |
The deeper structures are anesthetized | 77.3 | 94.1 |
Using the large needle- (or catheter-) syringe complex, the vein is cannulated while aspirating (must be done with ultrasound) | 59.1 | 100 |
Syringe is removed from the needle and the needle is held steady | 63.6 | 94.1 |
The guidewire is advanced into the vein no more than 10-20 cm | 22.7 | 100 |
The skin is knicked where the guidewire enters the skin (using a scalpel) | 68.2 | 88.2 |
The dilator is advanced over the guidewire and the vein is dilated. | 72.7 | 100 |
The catheter is advanced over the guidewire (with the guidewire held steady while catheter is moved forward) | 59.1 | 100 |
Never lets go of the guidewire | 54.5 | 100.0 |
As soon as line is in place, the guidewire is removed in its entirety | 68.2 | 100.0 |
The line was advanced 14-16 cm (any other measurement is wrong) | 31.8 | 100.0 |
Ensures there is blood flow from each port and flushes each port with sterile saline | 50.0 | 88.2 |
Line is secured in place | 54.5 | 100.0 |
Locks both ports with heparin or citrate | 40.9 | 94.1 |
Places dressing over line or verbalize this | 45.5 | 88.2 |
Requests a chest x-ray to confirm location | 54.5 | 94.1 |
Notifies or places order that line is ok to use | 45.5 | 100.0 |
Maintained sterile technique throughout | 50.0 | 100.0 |