Central venous access
- Prep and drape widely.
- Setup access kit to have the 11 blade, micropuncture wire, and 3/5Fr transitional dilator readily available.
- Infiltrate lidocaine into the access area and access the vein or artery using ultrasound guidance).
- Pass micropuncture wire and confirm desired pathway via fluoroscopy. Realize that there will be a change in the resistance of the wire as it transitions between the floppy segment of the wire and the stiff segment of the wire.
- Make a skin knick. Optionally, this step can be done prior to accessing the artery or vein.
- Exchange the 21-gauge needle with the 3/5Fr transitional dilator and exchange the inner cannula/0.018 wire with a 0.035 wire.
- For large catheter placements such as tunneled dialysis catheters and pheresis catheters, ensure the 0.035 wire progresses into the IVC for stability for future dilators and the peel-away sheath.
- Exchange the 5 Fr transitional dilator with the next desired catheter such as a vascular sheath, peel-away sheath, or other sheath.
- If this is an arterial puncture, connect the sheath side-arm to a heparinized saline flush after purging air bubbles from the circuit.