PRESENTED BY

NAVJOT KAUR BAJWA

MSC(N) 1ST YEAR
(OBG)

DEFINITION
A central

venous catheter, also called a central

line, is a long, thin, flexible tube used to give
medicines, fluids, nutrients, or blood products
over a long period of time, usually several
weeks or more.

TYPES OF CATHETER

Non-tunneled vs. tunneled catheters

Implanted port

PICC line

ANATOMY

INDICATIONS
Administration of agents into the central vasculature
Central circulation and intracardiac access
Hemodialysis and plasmapheresis
Monitoring of the central venous pressure (CVP) in
acutely ill patients to quantify fluid balance
Long-term Intravenous antibiotics
Long-term Parenteral nutrition especially in chronically
ill patients
Chemotherapy

ARTICLES

 Central

venous catheterization kit

Clear fenestrated plastic drape

Paper drape
Chlorhexidine antiseptic with applicators
1% Lidocaine
Small anesthetizing needle (25 gauge 1 inch)
Large anesthetizing/finder needle (22 gauge 1.5

inch)
Introducer needle (18 gauge 2.5 inch)
Several syringes, 5 mL each

CONTD

J-tipped guidewire with housing and a straightener sleeve

Scalpel with a No. 11 blade
Skin dilator
Catheter (e.g., triple lumen or sheath introducer)
Gauze pads
Suture with curved needle
Disposable needle holder

Sterile gloves, sterile gown, cap, and mask with a fluid

shield for each member of the insertion team
Large sterile drape (half-sheet)
Lidocaine 1% (often provided in the kit, although extra
may be required)
Sterile saline suitable for injection
Sterile dressing (e.g., Tegaderm, 3M Corporation,
Huntingdon Valley, PA)

PROCEDURE
Explain the procedure to the patient. Taken the
consent from patient and prepare the patient for
procedure.
Set the oxygen, a pulse oximeter, and a cardiac
monitor
Give 15- to 30-degree trendelenburg position to
the patient.
Gather the equipment.
Sterilize the field. Prepare your equipment.
Flush all ports, and attach end caps to the
proximal and middle ports.
Identify landmarks.

CONTD
Palpate the subclavian as it bends at the junction
of the medial third and lateral two thirds of the
clavicle.
Select an insertion point.
Anesthetize the insertion site. See Local
Anesthesia for further details.
Locate the vein with the introducer needle
(infraclavicular approach).
Insert the introducer needle 1 cm inferior to the
junction of the middle and proximal third of the
clavicle while aiming slightly cephalad. Maintain a
5- to 10-degree angle relative to the chest wall

CONTD
Insert

the needle with the bevel directed

inferiorly.
Locate the vein with the introducer needle
(supraclavicular approach).
Insert the introducer needle 1 cm lateral to the SCM

and 1 cm superior and posterior to the clavicle.

Aim toward the contralateral nipple.
Insert the needle with the bevel directed medially.
Advance

the guidewire into the vessel.

Hold the guidewire and remove the introducer
needle.

CONTD.
Nick

the skin with the scalpel to enlarge the

puncture site.
Triple-lumen catheter insertion:
Advance the dilator over the guidewire, and then
remove it.
Advance the catheter over the guidewire.
Remove the guidewire.
Withdraw blood from the port to confirm location
within lumen of a vein.
Flush the line and ports with sterile normal saline.

CONTD
To

insert a sheath introducer:

Fully insert the dilator into the sheath
introducer before advancing it.
Advance the dilator and sheath introducer as
a unit over the wire and into the vessel.
Remove both the dilator and the guidewire
as a unit.
Confirm placement and flush the line with
saline.

CONTD
Final

steps
Secure the catheter at the insertion site with
suture.
Cover the site with a sterile transparent occlusive
dressing.
Order a chest radiograph.