Get Central Line Placement Form - Iscu Picu - Utmb

Filling out the Central Line Placement Form is an important task for healthcare professionals in the ISCU PICU setting. This guide provides clear, step-by-step instructions to help users accurately complete the form online, ensuring compliance with central line insertion practices.

Follow the steps to accurately complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the data collected by you in the relevant field. This may include your name and the initials of the patient. Be sure to include the unique hospital number assigned to the patient.
3. Fill in the date of insertion, patient's date of birth, and gender by selecting the appropriate options.
4. Indicate the event type by marking the appropriate checkbox, selecting from options such as CVC, PAC, PICC, or UAC/UVC.
5. Specify the location of the patient by checking the relevant box - MICU, SICU, BICU, TDCU, ISCU, or PICU.
6. Fill in the site of insertion, choosing from the options provided, such as subclavian, internal jugular, arm (PICC), femoral, or scalp.
7. Record the operator's name, occupation, and select the role of the central line inserter by checking the relevant box.
8. State the reason for inserting, marking the appropriate boxes and providing additional explanations if necessary.
9. Complete the insertion practices section by answering the questions regarding practices such as mask donned, hand hygiene, and use of sterile equipment.
10. After completing the questions, please include the number of skin punctures as applicable.
11. If necessary, document any additional breaks in technique that occurred before catheter insertion.
12. After filling out the form, review all entries for accuracy and completeness.
13. Finally, save your changes, and if needed, download, print, or share the completed form.

Complete your documents online efficiently to enhance care delivery.