Central Venous Line Insertion

All central venous (CV) lines need to be inserted with strict adherence to our local ICU policy which is modified from the Trust guidelines and available on the I drive in the ACCU folder.

I:\surgery_&_anaes\ACCU\Policies and Guidelines

At induction you will be asked to document your current competence and knowledge of safe line insertion technique. If you do not feel confident inserting lines independently please let the senior ICU trainees and your educational supervisor know as we can help train you.

In summary, when you place a central venous catheter you must use full aseptic technique including gown, gloves and a mask and clean with 2% chlorhexidine / 70% alcohol solution (not 0.5% chlorhexidine). It must be documented, either by filling out and placing in the notes the sticker usually found inside the line insertion pack or by writing directly into the notes.

Following insertion of all CVCs:

  • Confirm venous placement by transducing the line to confirm a venous pressures and/or waveform.
  • When venous placement is confirmed, the line can be used with immediate effect.

A chest X-ray is NOT needed following insertion of uncomplicated right internal jugular CVCs under ultrasound, as long as a CVP trace is obtained.

DO a chest X-ray after insertion of:

  • Subclavian vein CVCs (higher risk of pneumothorax)
  • Complicated internal jugular CVC insertion (multiple passes, small veins, multiple previous CVCs / vascaths / tunnelled HD catheters)
  • Left internal jugular vascaths (ensure that the line is not tenting the SVC)
  • Remove old lines within 30 minutes of insertion and confirmation of new line.

Access for CRRT
There is a myriad of data which confirms that the correct placement of CV access for CRRT improves filter life span (including from this unit).  Please ensure you use the correct length line and aim to get the tip of the CV line in (at) the right atrium / lower SVC for lines placed in the IJ or (in the rare occasion you used it) the SC vein. All femoral lines should be the longest line available.  Refer to the guide in the Renal Room.