Central venous access

Pre-procedural evaluation

Steps

  1. Prep and drape widely.
  2. Setup access kit to have the 11 blade, micropuncture wire, and 3/5Fr transitional dilator readily available.
  3. Infiltrate lidocaine into the access area and access the vein or artery using ultrasound guidance).
  4. 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.
  5. Make a skin knick. Optionally, this step can be done prior to accessing the artery or vein.
  6. Exchange the 21-gauge needle with the 3/5Fr transitional dilator and exchange the inner cannula/0.018 wire with a 0.035 wire.
    1. 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.
  7. Exchange the 5 Fr transitional dilator with the next desired catheter such as a vascular sheath, peel-away sheath, or other sheath.
    1. If this is an arterial puncture, connect the sheath side-arm to a heparinized saline flush after purging air bubbles from the circuit.

Contributing Authors

Kevin Liu