Central Venous Line Placement

Introduction

A central venous line is utilized in critically ill patients to deliver essential medications and monitor vital signs closely.

Procedure Overview

1. Patient and Bed Positioning

   • Position the bed at a 10° Trendelenburg angle to enhance venous filling.
   • Turn the patient's chin to the opposite side of the insertion site for better access.
   • Attach an EKG monitor to observe the patient's cardiac status throughout.

2. Preparation

   • Place a small towel between the shoulders to gently extend the neck, improving vein visibility.
   • Scrub the insertion area thoroughly with antiseptic.
   • Drape the area with a sterile drape to maintain a sterile field.

3. Catheter Selection and Preparation

   • Choose an appropriate central line catheter for the patient.
   • Flush each lumen to confirm patency and ensure the guide wire can pass easily.

4. Insertion Steps

   • Inject local anesthetic at the insertion site to minimize discomfort.
   • Insert the needle into the vein with negative pressure to confirm entry.
   • Check for nonpulsatile dark venous blood flow to verify venous access.
   • Advance the guide wire through the needle into the subclavian vein.
   • Withdraw the needle, leaving the guide wire in place.

5. Catheter Placement

   • Make a small skin incision with a scalpel.
   • Use a dilator over the guide wire to widen the tract.
   • Clean the area around the insertion site.
   • Place the catheter over the guide wire and advance it to the desired depth.
   • Unclamp the catheter and check for blood return from each port to confirm positioning.

6. Completion

   • Flush each lumen and cap the port.
   • Securely suture the catheter in place to prevent dislodgment.
   • Apply a sterile dressing over the insertion site.

Post-Procedure Care

• Check Patient's Breathing
  • Rule out complications such as pneumothorax or pleural effusion.

Additional Resources

• To watch a video on pleural effusion and how it is drained, click the following link.