Central Vascular Access Drvice Insertion

The State of Queensland (Queensland Health), 2011. Permission to reproduce should be sought from (Affix identification label here). URN: Family name: Central Vascular Access Device Given name(s): Insertion Address: Date of birth: Sex: M F I. Facility: A. Interpreter / cultural needs The device may become blocked and need medications to unblock or may need to be An Interpreter Service is required? Yes No removed. If Yes, is a qualified Interpreter present? Yes No (Tunnelled and Non-tunnelled catheters only) The A Cultural Support Person is required? Yes No device may be accidentally removed if pulled or If Yes, is a Cultural Support Person present? Yes No tugged on. Failure of local anaesthetic which may require a B. Procedure further injection of anaesthetic or a different The following will be performed (Doctor/doctor method of anaesthesia may be used.)

In recommending a Central Venous Access Device, the doctor believes the benefits to you from having this procedure exceed the risks involved. The risks and complications with this procedure and with having a device can include but are not limited to the following. Common risks and complications include:

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  Devices, Access, Central, Vascular, Venous, Central venous access devices, Central vascular access

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