What are the steps for inserting a Central Venous Catheter (CVC)?

From the Guidelines

Central line insertion should be performed using maximal sterile barrier precautions, including cap, mask, sterile gown, and gloves, and with ultrasound guidance to minimize the risk of complications and infections, as recommended by the most recent and highest quality study 1. The steps for inserting a Central Venous Catheter (CVC) include:

• Gathering all necessary equipment, including sterile gown, gloves, mask, cap, ultrasound machine, central line kit, chlorhexidine solution, and lidocaine
• Positioning the patient in Trendelenburg position (head down 15-30 degrees) if inserting into the internal jugular or subclavian vein to increase vein distension and reduce air embolism risk
• Performing a time-out to verify patient identity and procedure
• Preparing the skin with chlorhexidine and allowing it to dry completely
• Using ultrasound guidance to identify the target vessel and surrounding structures
• Administering local anesthesia with 1-2% lidocaine
• Inserting the needle under ultrasound guidance at a 45-degree angle for internal jugular approach or 30-degree angle for subclavian approach
• Threading the guidewire, removing the needle, making a small incision, dilating the tract, and threading the catheter over the wire
• Removing the wire while holding the catheter in place
• Aspirating all ports to confirm blood return, flushing with saline, and securing the catheter
• Applying a sterile dressing and obtaining a chest X-ray to confirm proper placement and rule out pneumothorax It is also important to note that antimicrobial prophylaxis is not recommended for CVC insertion 1, and that the femoral vein should be avoided as an insertion site due to the increased risk of infection and thrombosis 1. The use of chlorhexidine solutions with alcohol is recommended for skin preparation 1, and routine flushing with saline is recommended after the completion of any infusion or blood sampling 1. Overall, the key to successful CVC insertion is to follow a standardized protocol that prioritizes sterile technique, ultrasound guidance, and careful patient monitoring, as outlined in the most recent and highest quality study 1.

From the Research

Steps for Inserting a Central Venous Catheter (CVC)

• Preparation:
  • Ensure proper training and expertise in inserting CVCs 2
  • Use sterile technique during catheter insertion to reduce the risk of central line-associated bloodstream infections (CLABSIs) 2
• Site Selection:
  • Choose an appropriate site for CVC insertion, taking into account factors such as patient anatomy and potential complications 3
• Skin Preparation and Insertion:
  • Prepare the skin with antiseptic solutions to reduce the risk of infection 4, 2
  • Insert the catheter using aseptic technique to minimize the risk of contamination 4, 2
• Securement and Maintenance:
  • Secure the catheter in place to prevent dislodgement and reduce the risk of complications 3
  • Regularly maintain and monitor the catheter to prevent infections and other complications 4, 3

Important Considerations

• Adherence to proper sterile technique during CVC insertion is crucial to reduce the risk of CLABSIs 2
• The use of antimicrobial-coated CVCs may help reduce the risk of CLABSIs, but its effectiveness is still being studied 5
• Regular monitoring and maintenance of CVCs are essential to prevent complications and ensure patient safety 4, 3