- Femoral-Just medial to the femoral pulse. If absent try to feel for pulse with compressions or use your hand. Put your thumb at symphysis pubis and index on ASIS. Aim for just medial of the middle of the “V”
- Internal Jugular-Just between the bellies of the sternocleidomastoid muscle.
- Subclavian-outer third of the clavicle and direct needle towards sternal notch. Go just under the clavicle
Thursday, May 2, 2013
Central Line Insertion Landmarks
Central Line Insertion
- Time Out Procedure
- Prep the area with chloroprep with or without betadine and sterile drape in the usual fashion
- Palpate the appropriate landmarks (see below)
- Once you get venous return, thread the guidewire (seldinger technique), remove the needle.
- Make an incision at the top of the wire with an 11 blade scalpel.
- Dilate the wire with dilator and remove the dilator
- Thread the catheter over the wire and remove the wire when advancing the catheter.
- Always have a hold of the wire before advancing catheter.
- Get a STAT portable CXR to confirm placement
- It is considered the standard of care to use ultrasound guidance for internal jugular and femoral vein catherization if it is available to you.
Central Line Equipment
- Lidocaine
- 10 mL syringe for anesthetic
- Chloroprep with or without betadine
- 4 x 4 gauze spones
- Sterile Drapes
- Central Line Kit (Cordis, Precept, Triple Lumen, or Swan Ganz Catheter)
- Silk or nylon Suture (2.0-3.0)
- Saline Flushes, Stat Lock, and Tegaderm Dressing
Central Line Complications
- Pneumothorax
- Hemothorax
- Catheter embolizations
- Vascular laceration or hemorrhage
- Infection
- Hematoma
Central Line Contraindications
- Anatomic deformity
- Anticoagulation, bleeding disorders, or thrombolytic therapy
- Pneumothorax on ipsilateral side
- Vasculitis, phlebitis,, or IV drug abuse of involved vessels
Central Line Insertion Indications
- Emergency Venous Access
- Rapid Volume Resuscitation (Cordis Catheter)
- Central Venous Pressure Monitoring
- Hyperalimentation
- Sepsis with MAP less than 65
- Hypotension with need for long term vasopressors
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