In addition to today’s resource, please carefully review Hemodynamic access for the crashing patient: The dirty double. This outstanding post details how to very rapidly obtain Femoral Arterial and Venous Access in an emergency.
March 1, 2015 by Dr. Josh Farkas.
In this post, I link to and embed the video from Behind The Knife-The Surgery Podcast, EASY Central Line Placement (Central Venous Catheter) | Behind the Knife – Bedside Procedures Ep 2, 13:57, Aug 1, 2020.
**As a couple viewers have noted, we accidentally left out the shot where we removed the wire! You should remove the wire after the catheter is inserted over it! 🙂 **
I LOVE placing central lines! Join me as we learn how to EASILY nail the IJ, subclavian, and femoral central lines.
If you haven’t already seen our video on Ultrasound-Guided Access, consider watching that first! https://www.youtube.com/watch?v=5IcVA…
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Intro: (0:00) Positioning: (0:37) Landmarks and ultrasound: (1:12) Gathering Equipment: (2:05) Priming Equipment: (3:19) Procedural Steps: (4:10) Subclavian and Femoral Lines: (10:44) Outro: (13:01)
Supplies you should gather (many will be in the kit):
Prep stick and drape Gauze and sterile dressing Catheter and 3 caps
Local anesthesia, needles, and syringe
Finder needle and syringe Guidewire
11-blade knife
Skin dilator Sterile
saline flushes
Suture, needle, and catheter fastener
Ultrasound Ultrasound probe cover Pressure transducer (if available/desired)
Preparation Tips and Tricks: Clear room at the head of the bed Bring patient head to edge and place in Trendelenburg with height to your preference When placing probe cover, remove all folds from the plastic and remove all air bubbles from the gel Flush catheter lines before use Ensure guidewire glides smoothly and prime the cheater Stage all your equipment in order of use Key Steps of the Procedure: Infiltrate local anesthesia Use ultrasound to guide finder needle down to vessel Place guidewire to 20cm depth Make nick in skin with blade, then dilate tract Feed catheter over guidewire, advance to desired depth, remove wire Aspirate from and flush all ports Sew in catheter, including using the catheter fastener Call for confirmatory x-ray
