Overview

Central Venous Catheter insertion is a procedure used to place a catheter in a large central vein for administration of medications, fluids, or monitoring central venous pressure.

CVC insertion is crucial for critically ill patients requiring long-term venous access, hemodynamic monitoring, or administration of vasoactive medications.

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Indications

✓
Long-term IV Access

Chemotherapy, TPN

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Hemodynamic Monitoring

CVP measurement

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Vasoactive Medications

Pressors, inotropes

✓
Hemodialysis

Temporary access

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Emergency Access

Rapid fluid resuscitation

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Local infection
✗ Thrombosis

Relative Contraindications

✗ Coagulopathy
✗ Pneumothorax
✗ Previous surgery

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient consent, sterile technique, equipment setup, and understanding contraindications.

Step-by-Step Procedure

Step 1: Patient Preparation

Explain procedure, obtain consent, position patient.

⚠️ Common Mistakes to Avoid:

  • Inadequate consent
  • Poor positioning

💡 Pro Tip:

Position patient in Trendelenburg.

Step 2: Site Selection

Choose appropriate vein (IJ, subclavian, femoral).

⚠️ Common Mistakes to Avoid:

  • Wrong site
  • Poor landmarks

💡 Pro Tip:

Use ultrasound guidance.

Step 3: Sterile Preparation

Prep and drape sterile field.

⚠️ Common Mistakes to Avoid:

  • Inadequate prep
  • Contamination

💡 Pro Tip:

Use strict sterile technique.

Step 4: Local Anesthesia

Infiltrate local anesthetic.

⚠️ Common Mistakes to Avoid:

  • Inadequate anesthesia
  • Wrong technique

💡 Pro Tip:

Anesthetize skin and subcutaneous tissue.

Step 5: Venipuncture

Puncture vein with proper technique.

⚠️ Common Mistakes to Avoid:

  • Wrong angle
  • Multiple attempts

💡 Pro Tip:

Use ultrasound guidance.

Step 6: Catheter Insertion

Insert catheter over guidewire.

⚠️ Common Mistakes to Avoid:

  • Wrong depth
  • Kinking

💡 Pro Tip:

Measure appropriate length.

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Post-procedure Care

Post-procedure care involves monitoring for complications, dressing changes, and catheter maintenance.

Complications & Management

Complication Incidence Signs Management Prevention
Pneumothorax 1-3% Chest pain, dyspnea Chest X-ray, chest tube Ultrasound guidance
Infection 2-5% Fever, erythema Antibiotics, removal Sterile technique
Bleeding 1-2% Hematoma, hypotension Pressure, transfusion Check coagulation
Arterial puncture 1-3% Bright red blood Pressure, observation Ultrasound guidance

Clinical Pearls

💡

Use ultrasound guidance for all insertions.

🎯

Choose appropriate site based on indication.

⚡

Use strict sterile technique.

🔍

Confirm position with chest X-ray.

📊

Monitor for complications.

🎨

Secure catheter properly.

⚠️

Remove when no longer needed.