In general cannulation of the internal jugular (IJV), subclavian (SCV) and femoral vein (FV) can be guided by anatomical landmarks; however guidelines produced by the UK National Institute for Clinical Excellence advise the use of ultrasound-guided techniques.

The Seldinger technique is most commonly performed, and consists of a guidewire inserted through a needle before the catheter is passed.

Equipment

1. ▪ Sterile – gown, gloves, mask

2. ▪ Central venous catheter pack

3. ▪ Aseptic solution

4. ▪ Local anaesthetic

5. ▪ Blade

6. ▪ Three-way taps

7. ▪ Suture/clear dressing

8. ▪ Pulse oximeter and cardiac monitor.

Technique for insertion

1. ▪ Obtain consent.

2. ▪ Proper positioning of patient will enhance success.

3. ▪ Aseptic technique.

4. ▪ Local anaesthetic infiltration (if patient awake).

5. ▪ Flush the catheter with saline (all ports).

6. ▪ A metal needle attached to a syringe is advanced subcutaneously towards the vessel while continuously aspirating, until venous blood is aspirated.

7. ▪ Remove syringe and pass guidewire though needle. If blood pulses out this suggests an arterial puncture. In this case remove needle and apply pressure. If resistance is encountered remove the guidewire and re-insert the needle.

8. ▪ Monitor for arrhythmias (if IJV or SCV): retract wire slightly if this occurs.

9. ▪ Enlarge the skin puncture site with scalpel incision, and remove the needle, leaving the guidewire in situ.

10. ▪ Pass the dilator over the guidewire to form a tract through subcutaneous tissue. The dilator only needs inserting a few centimetres; the vein does not need dilating.

11. ▪ Remove the dilator, and thread the catheter over the wire ensuring that the end of the wire always protrudes for the catheter. This will prevent loss of the wire.

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