Central venous cannulation - how to insert a central line
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
- Damage to the vein or adjacent structures such as artery or nerve
- Sedation may be required to insert the cannula
- Vein trombosis, thrombophlebitis
- Cardiac arrhythmias
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
- Sterile dressing
- Pressure bag to attach for monitoring
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!