ICU Procedures Data Collection
To be completed after performing or attempting any of the below procedures, including if unsuccessful.
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Proceduralist *
Doctor *
Person who inserted the line
Observers / Assistants / Supervisors . State if any:
Date (Only required if entering retrospectively)
MM
/
DD
/
YYYY
UR Number *
Procedure Type *
Click "Other" Only if not listed in list. Need to be specific for statistics.
Number of Attempts. Note single skin puncture can include multiple attempts at a vessel. *
Was the procedure successful?
Clear selection
Was ultrasound guidance used?
Clear selection
If procedure was unsuccessful, what action was taken?
Complications
Review
Submit
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