Central venous catheter placement

  1. Select appropriately-sized catheter kit (for children, default 4F 8cm, shorter for infant neck line and longer for older child femoral line)
  2. Identify anatomic landmarks
  3. Locate the pulse (for IJ and femoral)
  4. Appropriately prepare and drape patient (full sterile barrier for non-emergent, sterile as situation allows for emergent)
  5. Manipulate syringe correctly (negative pressure on plunger while advancing syringe and needle. Plunger head between IF and MF, thumb on flange of syringe, like pencil grip)
  6. Follow the needle with ultrasound (if used) in long and short axis (in and out of plane)
  7. Stabilize needle
  8. Disconnect syringe with twisting motion without displacing needle
  9. Manipulate wire (slides wire into needle and vein using alternating grasp and release)
  10. Make appropriate skin incision (blunt side of blade on wire, wiggles the wire to assure no skin bridge)
  11. Load dilator (rests the end of the guidewire on a fingertip to stabilize along one plane)
  12. Dilate tract (left hand holds wire and provides counter-tension on skin, advances dilator through skin in twisting motion, grasps body of dilator and not hub)
  13. Place line over wire (stabilizes wire on fingertip, skin counter-tension)
  14. Assure first port is not clamped so wire is not advanced into patient
  15. Remove wire (slides wire out of vein and needle by alternating grasp and release backwards)
  16. Flush catheter correctly (lure lock caps on catheter hubs, syringe held vertical, aspirates air bubbles first, then flushes line)
  17. Secure line appropriately (biopatch, sutures, tegaderm, sutures extra rubber clamp if used as well as junction hub, covers both with tegaderm)