The most nerve-racking step of central line placement for the inexperienced practitioner is accessing the vein. My preferred way to safely access the vein for central line placement is to use the Modified Seldinger Technique. In some studies for ultrasound-guided internal jugular vein catheterization, the modified Seldinger techniqueshowed superiority over the Seldinger technique in terms… Continue reading Central Line Placement: The Seldinger Technique
The Optimal Depth to Insert a Central Venous Catheter Don’t make it harder than it should be. There are two key points to keep in mind for patient safety regarding how deep to insert a central venous catheter. They are as simple as don’t insert the catheter too deep and don’t place the catheter too… Continue reading How Deep to Insert a Central Venous Catheter
By convention, peripheral IV catheters are sized in gauge, and central venous catheters (CVCs) are sized in French. This table compares French sizing to gauges for catheters with flow rates. Comparing French Sizing to Gauges with flow rates Poiseuille’s Law for IV Flow Rates Catheter sizes are critical if you are trying to rapidly transfuse… Continue reading Comparing French Sizing to Gauge for IVs and Central Venous Catheters
The central line insertion location has an outsized impact on a number of quality metrics related to central line safety. Sadly, the 20 y/o intern there to place the line, often late in the afternoon, rarely can connect their choice of location to the care and maintenance of that line by the nursing staff and… Continue reading Ultrasound-Guided Subclavian Central Line Placements
Rapid Central Vein Assessment (RaCeVA) is a systematic, standardized approach for ultrasound assessment before central venous catheterization. Ultrasound use for central line placement not only provides superior procedural advantages but can also be used to perform a thorough assessment of the vascular structures to evaluate vessel health, viability, size, and patency, including the location of… Continue reading What is Rapid Central Vein Assessment (RaCeVA)?
I wasn’t very familiar with the term “double-stick” when I went through my anesthesia residency. Although we did the typical “big cases” and trauma, we did not routinely place two central lines in a single vein of the same patient. In my current practice, however, it is very common to place two central venous catheters… Continue reading Should You Double-Stick Your Central Lines?
If you want to know what type of central venous catheter your patient needs, this is the place to start. The first step of central venous catheter placement is confirming the patient actually needs a central venous catheter and consents to the procedure. Once you know that your patient needs a central line, the question… Continue reading 7 Different Types of Central Venous Catheters
If you have ever tried to place an IV or use an angiocatheter to access the vein for a central line, you familiar with the experience of a “dry thread.” A “dry thread” is the experience of getting a flash confirming that you are in the vein, but the catheter is placed What is a… Continue reading Why you dry thread your IVs and angiocatheters
Central line placement is as standardized of a procedure as you can find in healthcare. No matter the city or hospital, the steps are exactly the same without much debate except for the great divide; using a steel needle vs angiocatheter to access the vein. If you are getting into a debate, it is important… Continue reading Central Line Placement: The Steel Needle vs Angiocatheter Debates
Central line placement is a very safe procedure in experienced hands. However, each year a new group of medical trainees arrives and needs to be quickly educated about how to perform safe central line placement. If you are a trainee looking to learn safe central line placement, there are two key techniques for safe central… Continue reading Central Line Placement: Ultrasound Vs Manometry