Needle puncture only: Remove the needle and hold pressure.Identify the location with the greatest separation between the IJV and carotid artery.Use real-time ultrasound for line placement.Perform a preprocedure scan to identify the best cannulation site.Ĭommon pitfalls in internal jugular vein central line placement Hold the guidewire at all times when performing steps according to the Seldinger technique. Secure the catheter to the skin and apply a sterile dressing.Remove the guidewire, aspirate blood from all ports, and flush each port with saline.Remove the dilator and advance the catheter ∼ 16 cm (right IJV) or ∼ 20 cm (left IJV) over the guidewire.Thread the vascular dilator over the guidewire and advance 5–7 cm in a spiral motion into the vein.Make a small skin incision over the guidewire.Remove the needle while holding the guidewire in place.Feed 15–20 cm of guidewire through the needle.Hold the needle firmly and remove the syringe.Apply negative pressure to the syringe plunger and advance the needle until blood flashback occurs.Place the needle beneath the center of the probe at a 45° angle to the skin.This approach uses a thin wall needle (referred to as “needle” from here on) and the Seldinger technique. Tunneled CVLs for long-term use nontunneled CVLs for short-term use.Hemodialysis catheters: can be a long-term CVL or a short-term CVL.Long-term CVLs: e.g., PICC lines, tunneled CVLs, surgically implantable catheters.Sheath introducer (large gauge): used for rapid or high-volume fluid administration, or to aid insertion of other lines (e.g., Swan-Ganz catheter).Small gauge: decreases the risk of vessel thrombosis.Single-lumen CVL: 1 channel allows administration of a single solution at a given rate.Double-lumen CVL: 2 channels typically large gauge that allows high rates of fluid exchange, e.g., for hemodialysis or plasmapheresis.Triple-lumen CVL: 3 channels allows simultaneous administration of multiple solutions at different rates.Short-term CVLs: nontunneled CVLs typically intended to remain in place ≤ 14 days.Higher risk of pneumothorax than IJ line.Enters below the left or right clavicle via the subclavian vein. ![]()
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