Central venous cannulation - how to insert a central line

| In Articles | 16th July 2020

ADVANTAGES OF CENTRAL VENOUS CANNULATION

  • Rapid volume loading
  • Central access for vasoconstrictors and parenteral nutrition
  • Continuous central venous pressure monitoring to assess response to treatment
  • Allows blood sampling - central venous oxygen saturation

DISADVANTAGES OF CENTRAL VENOUS CANNULATION

  • Requires compliant patient for insertion
  • Higher risk of complication in children than adults

USUAL SITES OF CENTRAL VENOUS LINE INSERTION

  • Femoral vein
  • Right or left internal jugular veins
  • Subclavian vein

COMPLICATIONS OF CENTRAL VENOUS CANNULATION

  • Pneumothorax
  • Haemothorax
  • Damage to the vein or adjacent structures such as artery or nerve
  • Sedation may be required to insert the cannula
  • Vein trombosis, thrombophlebitis
  • Infection
  • Embolisation
  • Cardiac arrhythmias
  • Haemorrhage

EQUIPMENT REQUIRED FOR CENTRAL VENOUS CANNULATION

  • Ultrasound and sterile ultrasound sheath
  • Sterile trolley
  • Sterile field, gloves, gown and mask
  • Seldinger central line kit
  • Saline flush
  • Lidocaine 4ml
  • Suture
  • Sterile dressing
  • Pressure bag to attach for monitoring
Equipment required for central venous cannulation

CENTRAL VENOUS CANNULATION - PROCEDURE

  • Identify the site of insertion
  • Clean skin
  • Insert local anaesthetic (lidocaine) under ultrasound guidance
  • While lidocaine kicks in flush all central line lumens then clamp all lumens except Seldinger port
  • Under ultrasound guidance take the Seldinger needle attached to the syringe and insert into the vein
  • When blood is freely aspirated remove the syringe and immediately insert the Seldinger wire. This should pass easily if in the right place!
  • Remove the needle while keeping hold of the inserted wire. Ensure that the wire stays in the vein!
  • Use a scalpel to make a small incision (approx 3mm) in the skin. This should be done cutting away from the wire!
  • Pass the dilator over the wire and gently but firmly dilate a tract through the vein. Have swabs ready in case of bleeding!
  • Remove the dilator and pass the central line over the Seldinger wire. Make sure you hold on to the end of the wire as you advance it!
  • Once the central line is in place remove the wire
  • Aspirate and flush all lumens, re-clamp and apply lumen caps
  • Suture the line to allow 4 points of fixation
  • Dress with a clear dressing but allow the point of insertion to be seen clearly!