The procedure mainly used for the CVP-continuous central venous pressure monitoring and for purpose of the fluid management, drug therapy etc. central venous catheter is placed either in the internal jugular vein or subclavian vein, femoral vein, axillary vein.
Infusion and fluid volume therapy
Patients requiring CVC for
Administration of special medications – vasopressors, antibiotic drugs, correction of
electrolytes, chemotherapy etc
Access in patients where peripheral access is not possible
Total parenteral nutrition
For the administration of the high osmolarity solution
for venous blood sampling
for the no peripheral venous access
patients with injured extremities
for the shock patients
Seldinger needle or valve needle
Guidewire with length marking flexible J- tip /straight tip
Scalpel 11 sizes with BP handle
Double lumen /triple lumen made of an opaque catheter made of polyurethane with a soft tip
With valves and three-way adapters
Colour coded Luer lock connection
Fixation wings for fixing the catheter
Luer lock syringe
Ultrasound sterile jelly
Drapes for the site (center hole )/normal drape
Tegaderm /condom or sterile gloves for the ultrasound probes
Drape for the ultrasound cable
Sterile solution for the skin preparation and alcohol-based disinfectant.
The appropriate size of suture for the catheter fixation
Tegaderm dressing or custom dressing for the CVP
Colour coding used in the CVP
Yellow color – CVP monitoring
The site chosen for insertion would depend on the clinical situation. Although subclavian lines are superior in terms of incidence of catheter-related bloodstream infections, in an unstable patient, it is preferable to use the internal jugular vein because of the higher probability of serious complications with the subclavian route.
If there is a likelihood of severe coagulopathy or very low platelet count, (before these parameters are known) the femoral site may be used.
Central line insertion is very rarely done as an emergency procedure – if you need to use inotrope/vasopressor for support of blood pressure, it is OK to use a peripheral IV line.
so, until you are able to get central access. Remember, stabilization of the patient is a priority -line insertion is not. Hence, a CVC should not be inserted without taking appropriate aseptic precautions. Do seek help from senior colleagues if you are not sufficiently experienced with the procedure
Inflammation of the skin at the site of puncture anatomical anomaly
Very severe pulmonary emphysema
Postoperative changes in the site area
Hematoma at the site of puncture
Pneumothorax or chylothorax
Incorrect catheter positions
Cardiac arrhythmias due to the incorrect intracardiac placement of the catheter
Endocarditis due to mechanical irritation
Arterial injuries due to incorrect puncture
Thrombophlebitis of superior vena cava
Thoracic duct injuries
Damage to brachial plexus
Damage to the phrenic nerve
Do not reuse the single-use materials
Use strictly aseptic precaution & techniques for the CVP.
Use the position of the patients in Trendelenburg