Central venous catheter placement (full-sterile technique)
Appropriately position the patient.
Sterilize the field. Don full sterile personal protective equipment per universal precautions, appropriately drape the area, and cover ultrasound transducer with a sterile covering.
Prepare your equipment. Locate the anesthetic syringe and fill it. Locate the introducer needle, guidewire, scalpel, and dilator. Clamp all ports of the catheter except the distal guidewire port.
Identify landmarks and locate anatomic structures with ultrasound. Distinguish artery from vein. The vein is usually compressible when pressure is applied by the ultrasound probe.
Anesthetize tissues overlying the vein with local anesthetic.
Insert the needle with the syringe attached, aspirating as you slowly advance. Follow the needle trajectory with ultrasound until the vein is entered and venous blood enters the syringe.
Stabilize the needle hub (with left hand in a wide-base like a pool cue).
Remove the syringe with minimal movement of the needle (use a twisting motion).
Gently advance the guidewire through the needle and into the vessel.
Remove the needle. Maintain a grip on the wire. Confirm placement of guidewire using ultrasound.
Make an incision at the site of the wire to facilitate dilator and catheter passage.
Wiggle the wire to ensure no “skin bridge” was left
Thread the dilator over the guidewire. Advance the dilator several centimeters into the vessel, then remove. Ensure the wire protrudes from the end of the dilator and is always firmly in your grasp.
Advance the catheter over the wire and into the vessel. The guidewire will emerge from the distal port and must be grasped before catheter advancement.
Remove the guidewire.
Cover the open port with your thumb or clamp the line until the needle-free cap is attached
Attach a needle-free cap to each port and unclamp all lines
Aspirate the air out of each line and flush with saline, then cap. Hold the syringe upright while aspirating and flushing so that air will float to the top and not re-enter the vessel.
Suture the catheter into place using nonabsorbable silk sutures.
Clean the surrounding area, then apply an antiseptic protective disc and simple adhesive dressing.