11. Tips on Lines and Tubes
Central Line Consults
- The APN team can help with line consults during the week, but it is important for resident team to be involved and familiar with line types
- For line consults that arise after hours and on weekends, determine whether the line removal/insertion is acute or elective
- Elective consults can be referred to Line Scheduling: 6-4371
- Requires a formal, complete Consult Note (use CVC note templates; see “Notes on Notes” above)
- Document the underlying diagnosis and what the line is needed for
- Assess labs à H/H > 10/30, Platelets > 50, normal K – discuss transfusing w/ fellow
- Do not offer referring service info on timing of line until discussed w/ fellow
- Consent and Census should reflect ALL these details for line insertions:
- Type of line: tunneled CVC, mediport, hemodialysis catheter
- Nature of line: tunneled vs. temporary (percutaneous, non-tunneled)
- Number of lumens: single or double
- Pheresis capable: yes or no
- Should it be left accessed: yes or no (mediports only)
- Do not specify Left/Right side for line placement consents or booking
- Line removals should be booked, listed, and consented with specifying what we are removing -- tunneled CVC vs. Mediport as well as where the line is being removed from (e.g. left neck, right chest etc.)
G-Tube / Feeding Access Consults
- Requires a formal, complete Consult Note (use note templates; see “Notes on Notes” above)
- Document underlying Dx and these specific details of current feeding:
- Does pt take anything by mouth?
- Is there clinical or imaging evidence of oropharyngeal aspiration
- How is the pt currently being fed? – what type of formula, rate, etc.
- Where is the pt currently being fed? – stomach, post-pyloric
- Is the pt currently on continuous or bolus feeds?
- Have bolus feeds into stomach ever been attempted? If not, why?
- Clinical evidence of gastroesophageal reflux? – pneumonia, arching, failure to thrive
- Relevant past surgical history, previous feeding access, etc.
- Plans/additional studies will then be determined by Fellow
- UGI is only required for certain patients (see pre-op G tube protocol)