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How To….

Ultrasound Central Line. How To…. equipment. Most providers no longer use landmarks for central line placement except for with subclavian lines and occasionally femoral lines Increased accuracy Increased efficiency Ability to confirm placement in real time. Standard of Care.

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How To….

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  1. Ultrasound Central Line How To….

  2. equipment

  3. Most providers no longer use landmarks for central line placement except for with subclavian lines and occasionally femoral lines Increased accuracy Increased efficiency Ability to confirm placement in real time Standard of Care

  4. Why use Ultrasound…

  5. Anatomy

  6. Trendelenburg positioning Phythagoreantheorem Positioning

  7. The Site Rite or the Zonare US machines • Sterile US probe Cover • Sterile Gloves • Betadine/Chlorhexidine • Sterile saline/ Blue caps • Central Line Kit • Should have everything else you need • A nurse ready to help if you need anything else What you’ll need

  8. Still use the Seldinger technique • Needle Wire remove needle Small incision at skin dilator back thread the wire through the triple lumen Remove wire suture in place • Never let go of the wire • Difference is you can use the US to see the vein and vein puncture • http://www.youtube.com/watch?v=cYzVPMQc3aY&feature=related Seldinger technique

  9. confirm

  10. Confirm

  11. Failure to identify the needle in the tissue.  Failure to distinguish between vein and artery.  Angling the transducer towards the entry site of the needle on the skin may help visualize the needle earlier. Avoid advancing the catheter if the needle tip is not visualized. Trendelenburg position, Valsalva Maneuver, Use caution when utilizing a long axis approach to central venous cannulation due to the inability to maintain visualization of the carotid artery at all times. Sterile US gel Pearls

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