Overview
Central Line Insertion is a critical procedure used to establish central venous access for administration of medications, fluids, and monitoring. It is essential for critically ill patients and those requiring long-term venous access.
Central line insertion is crucial for hemodynamic monitoring, administration of vasoactive medications, parenteral nutrition, and chemotherapy. It provides reliable venous access when peripheral access is inadequate.
Learn more in our comprehensive RxDx Surgery Course
Indications
Central venous pressure monitoring
Administration of pressors and inotropes
Total parenteral nutrition delivery
Administration of chemotherapeutic agents
Temporary hemodialysis access
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient consent, sterile technique setup, ultrasound guidance, monitoring equipment, and emergency backup. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Explain procedure, obtain consent, position patient, prepare sterile field.
⚠️ Common Mistakes to Avoid:
- Inadequate consent
- Poor positioning
- Incomplete sterile prep
💡 Pro Tip:
Ensure patient is comfortable and cooperative.
Step 2: Site Selection
Choose insertion site, mark with ultrasound guidance.
⚠️ Common Mistakes to Avoid:
- Wrong site selection
- Poor ultrasound visualization
💡 Pro Tip:
Use ultrasound to identify optimal vein and avoid arteries.
Step 3: Local Anesthesia
Infiltrate local anesthetic at insertion site.
⚠️ Common Mistakes to Avoid:
- Inadequate anesthesia
- Wrong technique
💡 Pro Tip:
Use adequate local anesthetic for patient comfort.
Step 4: Vein Puncture
Puncture vein under ultrasound guidance, confirm venous blood.
⚠️ Common Mistakes to Avoid:
- Arterial puncture
- Multiple attempts
💡 Pro Tip:
Always confirm venous blood return before proceeding.
Step 5: Guidewire Insertion
Insert guidewire through needle, confirm position.
⚠️ Common Mistakes to Avoid:
- Wrong guidewire placement
- Guidewire loss
💡 Pro Tip:
Maintain control of guidewire at all times.
Step 6: Catheter Insertion
Insert catheter over guidewire, remove guidewire.
⚠️ Common Mistakes to Avoid:
- Catheter malposition
- Guidewire entrapment
💡 Pro Tip:
Ensure guidewire is completely removed.
Step 7: Confirmation
Confirm placement with chest X-ray, secure catheter.
⚠️ Common Mistakes to Avoid:
- Poor confirmation
- Inadequate securing
💡 Pro Tip:
Always confirm tip position before use.
Master Central Line with RxDx
Access 100+ procedure videos and expert guidance with the RxDx app
Post-procedure Care
Post-procedure care involves confirming placement with chest X-ray, monitoring for complications, daily line care, and timely removal when no longer needed.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Pneumothorax | 1-3% | Chest pain, dyspnea, decreased breath sounds | Chest X-ray, chest tube if needed | Ultrasound guidance, proper technique |
| Arterial puncture | 2-5% | Bright red blood, pulsatile flow | Remove needle, apply pressure | Ultrasound guidance, confirm venous blood |
| Infection | 3-8% | Fever, erythema, purulent discharge | Antibiotics, line removal | Sterile technique, proper care |
| Thrombosis | 5-10% | Arm swelling, pain, decreased flow | Anticoagulation, line removal | Proper positioning, timely removal |
Clinical Pearls
Always use ultrasound guidance for safer insertion.
Confirm venous blood return before proceeding.
Maintain control of guidewire at all times.
Always confirm tip position with chest X-ray.
Use sterile technique throughout the procedure.
Secure catheter properly to prevent dislodgement.
Monitor for complications post-procedure.