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.