| Course | NR 573 Advanced Acute Care Management Lab |
|---|---|
| Week | 2 |
| Paper type | Procedure note |
| Length | About 850 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Adult-Gerontology Acute Care NP (AGACNP) |
| Updated | October 2026 |
Free sample paper for NR 573 Week 2
Procedure Note: Ultrasound-Guided Right Internal Jugular Triple-Lumen Catheter in a Simulated Patient in Septic Shock, Placed on a Task Trainer in the Lab
Student Name
College of Nursing, Chamberlain University
NR 573: Advanced Acute Care Management Lab
Instructor Name
Month Day, Year
Procedure Note: Ultrasound-Guided Right Internal Jugular Triple-Lumen Catheter in a Simulated Patient in Septic Shock, Placed on a Task Trainer in the Lab
Setting
Simulation laboratory, acute care lab session 2. Scenario: a 68-year-old medical patient in septic shock from a urinary source on the second hour of norepinephrine through a peripheral line. Procedure performed on a neck and upper chest task trainer with ultrasound-compatible vessels. All patient details are part of the scenario.
Indication
Norepinephrine at 0.12 micrograms per kilogram per minute through a 20-gauge forearm line for 2 hours, with the dose rising, and difficult peripheral access after three failed attempts. A central line was indicated for reliable vasopressor delivery and because a second vasoactive drug was expected.
Consent
The patient was alert and able to decide. Risks discussed: arterial puncture, bleeding, pneumothorax, infection and failure. Alternatives: continuing peripheral vasopressor with frequent site checks, or a midline catheter. The patient agreed and signed. Time: 10:12.
Roles and Time-Out
Operator: me. Assistant and ultrasound holder: lab partner. Observer with the checklist: faculty. Time-out at 10:18: patient identity, procedure, right internal jugular site, allergies (none), anticoagulants (none; platelets 168, INR 1.1 in the scenario). All agreed.
Preparation and Site
Hand hygiene, then cap, mask, sterile gown, sterile gloves and a full-body sterile drape. Chlorhexidine with alcohol applied and allowed to dry for 30 seconds. Patient supine with 10 degrees of head-down tilt and the head turned about 30 degrees to the left. Pre-scan with a linear probe: right internal jugular vein 1.1 cm across, compressible, lateral to and not overlying the carotid artery at the level of the cricoid. Lidocaine 1%, 3 mL, infiltrated at the skin.
Events in Order
10:24. Introducer needle advanced in short axis under real-time ultrasound; needle tip followed into the vein; dark, non-pulsatile flow on the first pass.
10:25. Guidewire passed to 20 cm without resistance. Ectopic beats seen on the simulated monitor at 20 cm; wire withdrawn to 15 cm; ectopy stopped.
10:26. Guidewire seen in the lumen of the right internal jugular vein in short-axis and long-axis views before dilation; no wire seen in the carotid artery.
10:27. Small skin nick. Dilator passed over the wire to the depth of the vein only.
10:28. 16 cm triple-lumen catheter passed over the wire and secured at 14 cm at the skin. Guidewire removed and shown, intact, to the assistant; count confirmed aloud.
10:30. All three ports aspirated and flushed with saline; dark blood returned freely from each.
10:32. Catheter sutured and a chlorhexidine-impregnated sponge and transparent dressing applied.
Findings
Single pass. Vein entered on the first attempt. No arterial flash. No difficulty with the wire after withdrawal to 15 cm.
What Was Left in Place
16 cm triple-lumen central venous catheter, right internal jugular vein, 14 cm at the skin, sutured.
Checks After the Procedure
Wire: removed intact; confirmed by assistant at 10:28.
Blood return: present from all three ports at 10:30.
Waveform: transduced from the distal port at 10:34, showing a venous pressure trace with a value of 9 mm Hg, not an arterial trace.
Chest radiograph (scenario image), read at 10:52: catheter tip at the junction of the superior vena cava and the right atrium; no pneumothorax.
Breath sounds: equal on both sides at 10:40.
Use: cleared for vasopressor infusion at 10:55, after the radiograph.
Complications
None observed. The transient ectopy at a wire depth of 20 cm resolved on withdrawal and is recorded here because it happened.
Estimated Blood Loss
Less than 5 mL, estimated from the gauze used.
Orders After the Procedure
Label each lumen; distal lumen reserved for norepinephrine. Transfer the vasopressor from the peripheral line once the radiograph is read, without interrupting the infusion. Dressing change every 7 days or sooner if soiled or loose. Daily review of whether the line is still needed, recorded in the progress note. Check the insertion site and neck for swelling at 1 hour and at the next shift change.
Communication
The bedside nurse in the scenario was told at 10:55 that the line was confirmed and cleared for use, which lumen was assigned to the vasopressor and that the peripheral line should stay in place for 24 hours as backup. The line was entered on the line log with the date, site, depth at the skin and operator, so the day team can track its age.
Sources Behind the Steps
Real-time ultrasound guidance and confirmation of venous placement before dilation follow the central venous access guideline (American Society of Anesthesiologists Task Force on Central Venous Access, 2020). The short-axis and long-axis confirmation of the wire follows a structured review of ultrasound-guided placement (Saugel et al., 2017). A systematic review found that ultrasound guidance for the internal jugular vein lowered the risk of arterial puncture and failed placement compared with landmark technique (Brass et al., 2015).
References
American Society of Anesthesiologists Task Force on Central Venous Access. (2020). Practice guidelines for central venous access 2020: An updated report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology, 132(1), 8-43. https://doi.org/10.1097/ALN.0000000000002864
Brass, P., Hellmich, M., Kolodziej, L., Schick, G., & Smith, A. F. (2015). Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database of Systematic Reviews, (1), Article CD006962. https://doi.org/10.1002/14651858.CD006962.pub2
Saugel, B., Scheeren, T. W. L., & Teboul, J.-L. (2017). Ultrasound-guided central venous catheter placement: A structured review and recommendations for clinical practice. Critical Care, 21, Article 225. https://doi.org/10.1186/s13054-017-1814-y
Reading the NR 573 Week 2 instructions
The Week 2 assignment asks for a procedure note of about one page, written in short, past-tense sentences. It opens on the patient and the hour and on what made the procedure the right answer, before any mention of technique. Consent or the emergency exception comes next, stated in the note itself, followed by the people present and their roles. Preparation and site, events in the order they occurred, findings and what was left in place follow. The part most writers under-build is the last block: checks performed afterward and what each one showed. Most rubrics also look for the one complication this procedure carried a real risk of, rather than a copied list of every possible risk.
How the NR 573 Week 2 example is put together
The sample states its lab setting and scenario in two lines. The indication gives the vasopressor dose, how long it had run through a small peripheral line and the three failed attempts at access. Consent lists the risks and alternatives discussed. Roles and a time-out with the coagulation values follow. Preparation covers barrier precautions, skin antisepsis, positioning and the pre-scan of the vein. Events run minute by minute from needle entry to dressing, including ectopy at 20 cm and the two-plane wire check. A block of checks gives each one a time and a result. Orders, the handover to the nurse and the sources behind the steps close the note.
Where the points sit in the NR 573 Week 2 rubric
The heaviest marks in a procedure note go to the indication; a note that opens with equipment has no room left for the argument that the procedure was needed. Consent stated explicitly, including the emergency exception when it applies, fills the next criterion. Missing confirmation is the third common loss, because a device positioned and never verified reads as unfinished work; this sample confirms the wire, the blood return, the waveform and the tip position, each with a time. Clinical statements need a time or a value, which every event line here carries. Recording the minor ectopy, rather than leaving it out, earns honesty credit. A generic list of complications copied from a text loses points against the one specific risk.
NR 573 Week 2 help from the desk
Students in NR 573 Week 2 often begin the note with the equipment or the technique, which leaves the indication as an afterthought. Another common gap is consent implied by urgency but never stated. Many notes end when the catheter is in, with no record of how its position was confirmed. Adjectives such as successful or uneventful replace the values a reader needs. Some notes copy a full list of complications instead of naming the real risk for this site. Long sentences and present tense make the note read like an essay. If your lab procedure was different, send your timed notes from the session; a sample note for it can be drafted in the same order.
Get a NR 573 Week 2 example written to your instructions
Send the Week 2 assignment as your classroom posts it, with the rubric, the procedure you were given and any note template attached to it. A custom NR 573 procedure note is written to those details and returned inside 24-48h, the first one free, with the case constructed rather than taken from a real patient.
More NR 573 papers and AGACNP samples
- NR 573 Week 1: Procedure Note Line Discussion Post
- NR 573 Week 3: Simulation Debrief
- NR 573 Week 4: Complication Write-up
- NR 573 Week 5: Scenario Decision Log
- NR 573 Week 6: Team Communication Debrief
- NR 573 Week 7: Case Simulation Analysis
- NR 573 Week 8: Competency Reflection
- NR 572 Week 2: Rapid Assessment Write-Up
- NR 571 Week 2: Myasthenia and Pneumonia Case Paper
- NR 567 Week 2: CRRT Vancomycin Dosing Brief
- NR 570 Week 2: Bowel Obstruction Case Paper
NR 573 Week 2 questions, answered
Does a procedure note need references?
Most classroom versions want one or two, which is unusual for a chart document and tells you the piece is graded as academic work as well. The finished example puts them where they carry weight, behind the indication and behind the risk being monitored, rather than collected under a heading at the very end.
How long should the note run?
Roughly a page in most sections, and shorter is normal. Length is the wrong target, because a note is graded on whether each required element is present and defensible rather than on volume. What lengthens a weak note is narrative: sentences about the room, the equipment trolley and the writer's confidence, none of which a reviewer can use.
Can the note cover a procedure I only watched?
Check what your section allows, since practice differs. Where observation is permitted, the note is written from what the record would hold and claims no role the writer did not have. Where the assignment expects a simulated procedure the writer performed, the case is constructed and built to carry every element the rubric lists.
Where can I find a free NR 573 Week 2 sample paper?
The full procedure note for the ultrasound-guided internal jugular line on a task trainer, with timed events and post-procedure checks, is on this page.
What checks close the NR 573 Week 2 procedure note?
Wire removed intact, blood return from all three ports, a venous waveform on the transducer, a radiograph showing the tip position with no pneumothorax and equal breath sounds, each with its time.