Anesthesia/Sedation Preoperative Care and Preparation Clinical Pathway, Inpatient and Emergency Department

Vascular Access Considerations

Aim for at least one functioning IV prior to arrival in pre-procedure area.

Inpatient Vascular Access Pathway

Vascular Access	Inpatient/ED RN Actions Prior to Procedure
Peripheral IV	Assess IV for functionality Continuous fluids infusing Indications for continuous fluid administration Saline locked Flush prior to transfer to procedure area PIV access issues Contact procedure area charge RN Procedure area charge RN huddles with anesthesia provider to develop plan IV placement should NOT delay transport to the procedure area Inpatient Vascular Access Pathway Limit IV attempts to 2 per provider, for 2 providers (4 attempts) Notify VAS as indicated
Central Venous Catheters (CVC)	Ensure lumen functioning with enough time prior to procedure to allow for troubleshooting Lumen not patent, contact VAS All lumens utilized for continuous infusions Contacts procedure area charge RN Procedure area charge RN huddles with anesthesia provider to develop plan Heparin Flushing Guidelines for Central Venous and Midline Catheters

Vascular Access

Inpatient/ED RN Actions Prior to Procedure

Peripheral IV

Assess IV for functionality
Continuous fluids infusing
- Indications for continuous fluid administration
Saline locked
- Flush prior to transfer to procedure area
PIV access issues
- Contact procedure area charge RN
- Procedure area charge RN huddles with anesthesia provider to develop plan
- IV placement should NOT delay transport to the procedure area
Inpatient Vascular Access Pathway
- Limit IV attempts to 2 per provider, for 2 providers (4 attempts)
- Notify VAS as indicated

Central Venous Catheters (CVC)

Ensure lumen functioning with enough time prior to procedure to allow for troubleshooting
Lumen not patent, contact VAS
All lumens utilized for continuous infusions
- Contacts procedure area charge RN
- Procedure area charge RN huddles with anesthesia provider to develop plan
Heparin Flushing Guidelines for Central Venous and Midline Catheters

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Anesthesia/Sedation Preoperative Care and Preparation Clinical Pathway, Inpatient and Emergency Department

Vascular Access Considerations

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Anesthesia/Sedation Preoperative Care and Preparation Clinical Pathway, Inpatient and Emergency Department – Vascular Access Considerations

Anesthesia/Sedation Preoperative Care and Preparation Clinical Pathway, Inpatient and Emergency Department

Vascular Access Considerations