Central venous catheterization via a peripheral vein
For administration of prolonged or
concentrated IV fluids or drugs.
Suitable sites include the veins
of the antecubital fossa, or long saphenous vein anterior to the medial
malleolus or inferior–medial to the knee. Less preferred sites include the
axillary or scalp veins.
surgical instruments including fine forceps and scissors.
gloves, gauze swabs, gown, and drapes.
solution, e.g. 0.5% chlorhexidine.
27G silastic long line catheter. 27G should only be used when a 23G line cannot
syringe and heparinized (1U/mL) saline solution.
e.g. 19G butterfly needle, 20G IV cannula.
adhesive tape and transparent occlusive dressing.
distance from insertion site to just above the right atrium. Placing the
catheter tip in the right atrium risks pericardial tamponade.
insertion should be performed using strict aseptic technique.
hands and put on sterile gloves, gown, +/– surgical mask.
out equipment and prime catheter with sterile heparinized saline.
tourniquet proximal to selected insertion point.
relevant limb, then clean insertion site with antiseptic.
sterile drapes around insertion point to create sterile field.
introducer needle into the vein until blood flashes back. If using a cannula,
fine forceps advance catheter through introducer needle/cannula.
to advance catheter into vein until the desired distance is reached. Tip: often the catheter will meet
resistance as it becomes wedged against a kinked vein or valve. Milking in a
proximal direction with a finger over the catheter tip may facilitate further
tourniquet and then flush catheter with heparinized saline.
fully inserted, withdraw introducer needle/cannula. Remove from line after
unscrewing catheter hub. Reconnect hub to catheter.
haemostasis at puncture site by applying gentle pressure with sterile gauze
swab. This may take some considerable time!
line in place by using thin strips of sterile adhesive tape and sterile
transparent occlusive dressing.
infusion of heparinized saline (1U/mL) to keep line patent.
catheter tip placement with CXR. This may be aided by the injection into the
line of 0.5mL of contrast solution immediately before X-ray. Ideally, the
catheter tip should lie just proximal to the right atrium. Withdraw the
catheter before use if it is in the right atrium.