Central Venous Catheter Insertion 

Equipment: 

Personal protective equipment 
500 mL pressure infuser cuff 
Pressure monitoring system equipment 
Designated central line catheter (check with operator – how many lumen, and length) 
Sterile central line pack (contains drapes) 
Sterile Gloves and gown 
Transparent dressing 
10 mL syringes 
5 mL syringe 
Chlorhexidine (lollipop device if available) 
Normal saline ampoules – 4x10mls (minimum) 
Labels 
Dressing Trolley 
Normal Saline 500mls 
1% lidocaine (10mls) 
Blue needle 
Orange Needle 
Suture (2,0 prolene) 
3 way taps/octopus (dependent on local guidance) 
Suture cutter 
Ultrasound machine and appropriate probe (with sterile cover) 
Ultrasound gel 
Blood gas syringe 
Blood culture bottles (it is common to take blood cultures when a new line is inserted – before the line is used for anything else – where infection is suspected) 
 
Pre‐procedure 
1. Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent. 
2. Wash hands with soap and water, or an alcohol‐based handrub, and dry. 
3. Prepare the infusion and flush the transducer set using aseptic technique ensuring no air bubbles or kinks in the line. 
4. Check that all connections are secure. 
 
Procedure 

Note: A LOCSSIP should be completed for this procedure;  

1. Wash hands with soap and water, or an alcohol‐based handrub, and dry. Put on PPE. 
2. Prepare a trolley near the patient. 
3. Assist the operator to tie gown and assist with preparing equipment as directed by the operator (caution: this is a sterile field) 
4. Patient must be positioned lying on their back, 30 degrees reverse trendelberg (this is to prevent any air inadvertently entering the system whilst the line is being inserted – note: you must also lay the patient in the same position to remove the line) 
5. The operator will prepare the insertion site with drapes and clean with a 2% chlorhexidine before placing a sterile towel under the area. 
6.  The position of the vein is checked under direct vision, using an ultrasound machine. 
7. The operator will administer adequate local anaesthetic, a small incision is then made before the introducer is placed into the skin at the desired site. 
8. The catheter with the guidewire is inserted and observed for blood flashback. 
9.  The catheter is then advanced into position, the guidewire removed, and the line sutured into place 
Note: it is usual for TWO people to confirm the guidewire is removed 
10.  All lines are the aspirated and flushed with normal saline (3 way taps can be attached at this time 
11.  A blood gas is then taken to check the position of the line 
12.  A Chest X-ray is then ordered (usual practice outside of theatre environment) to check the position of the line 
13.  A transparent dressing is then placed over the cannula site and the patient can then be sat upright (Fowlers position 30 degrees) 
14. Attach the transducer set (first confirming it is flushed adequately) and open the roller clamp. 
15. Clearly label the device and dressing as well as on the tubing, adding the date of insertion. 
16. Connect the transducer to the monitoring equipment. 
17. Zero the arterial line in line with the phlebostatic axis (4^th intercostal space mid axillary line): 
 
(the transducer will read an arterial pressure calibrated to atmospheric air, which offsets the extraneous atmospheric and hydrostatic pressures). 

18.  Check the waveform is as expected, see: Invasive Monitoring – Waveforms – Art, CVP, PA, PCWP

Post‐procedure 

1. The operator should clearly document the date of insertion and the placement of the central line catheter in the patient’s records; documenting the line as safe to use. 
2. Set appropriate alarm limits on the monitor. 
3. Continue to monitor site at minimum hourly – checking for colour, warmth, and any signs of complications (see hazards and complications of central line access).