Resuscitative introducer sheath placement

Essential equipment

AntisepticIntroducer sheath kit (introducer needle, guidewire, scalpel, syringe, appropriately sized sheath-introducer system and associated dilator, line suture)Saline flushDressing


  1. Appropriately position the patient.

  2. Sterilize the field. Appropriately drape the area and don personal protective equipment per universal precautions.

  3. Locate the femoral pulse (midway between ASIS and pubic symphysis).

  4. Clamp the side port of the introducer sheath and insert the dilator.

  5. Insert the needle and syringe while slowly advancing and aspirating until venous blood is aspirated (femoral vein located medial to the artery).

  6. Stabilize the needle hub (with left hand in a wide-base like a pool cue).

  7. Remove the syringe with minimal movement of the needle (use a twisting motion).

  8. Gently advance the guidewire through the needle and into the vessel.

  9. Remove the needle. Maintain a grip on the wire.

  10. Make an incision at the site of the wire to facilitate dilator and catheter passage.

  11. Advance the dilator and sheath as a unit over the guidewire while holding tension on the skin with your non-dominant hand. Ensure the wire protrudes from the end of the sheath-dilator unit and is always firmly in your grasp.

  12. After full insertion of the sheath, remove the dilator and guidewire simultaneously.

  13. Aspirate air from the line with an upright syringe and flush port(s) with saline, then cap

  14. Secure and dress the line.