Assisting with Procedures

Lumbar Puncture

Lumbar Puncture Tray 1 Gather needed equipment:
  • Lumbar Puncture (LP) Tray
Lumbar Puncture Tray 2

Positioning the patient for an LPPositioning the patient for an LP
Properly positioning the patient is crucial.

Lumbar Puncture Location


The physician will collect multiple specimens, which must be labeled and handled correctly.
 


Insertion of a Subclavian Central Line

Subclavian insertion tray

 

Subclavian central line insertion tray
Subclavian tray up close

Contains:

  • skin preparations materials
  • Syringes and needles for administering local anesthetic agent and inserting the catheter
  • Scalpel for insertion incision
  • Suturing material to secure placement of the central line

Trendelenburg position

The patient is placed in Trendlenburg (observe them closely for signs of respiratory distress during the procedure)

If possible place a roll under the patient's shoulders for better access of the site.

Have the patient turn their head to the opposite side

Observe strict sterile technique: surgical gown, gloves, masks, head cover need to be used by physician and nurse


Cannulation of the subclavian vein

Insertion of Subclavian Catheter

The junction of the medial 1/3 and lateral 2/3 between clavicle and first rib with direction towards opposite shoulder is infiltrated with local anesthetic agent after preparing it with a cleansing agent.

The needle is inserted in to the punctured site and directed towards the suprasternal notch.

When blood is noticed in the needle coming freely into the syringe, syringe is removed and cannula is inserted in the subclavian vein.

The needle is subsequently withdrawn and cannula either locked or attached to IV drip. The cannula is anchored to the skin.

A dressing is then placed over the insertion site.


Videoclip of insertion of a subclavian catheter:

http://www.biodigital.org/voz2/W6SM.htm


 

Chest Tube Insertion

 

Chest Tube Tray

Gather equipment needed:

  • Chest Tube insertion tray
  • Mask, gown, and sterile gloves (check physician's glove size)
  • Local anesthetic
  • Occlusive dressing material and tape
  • Sterile water
  • Signed informed consent form

 

 


Chest Tube Insertion Locations

Position patient appropriately depending on location of chest tube.


Chest Tube Insertion Tray 1

Open sterile tray

Chest Tube Insertion Tray 2 After cleaning the area, the physician will lift the flap for the rest of the equipment.

Withdrawing local anesthetic 1
When assisting the physician to withdraw the local anesthetic, hold the vial down as air is injected into the vial.
Withdrawing local anesthetic 2
Then raise the vial, so that the local anesthetic agent can be withdrawn into the syringe.

Chest Tube Insertion
The chest tube will be placed so that all the drainage holes are within the pleural space.

Chest Tube Dressing
The chest tube site will be covered with an occlusive dressing


Video of Chest Tube Insertion:

Chest Tube Insertion