Internal Jugular Vein Catheterization || Central Line Procedure Step by Step !! CVP Line
Hi my self Dr Subodh Kumar, In this video i will show you step by step Central line insertion, Internal Jugular Vein line insertion procedure in ICU or Emergency.

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Pre-procedure
o Before starting procedure take a Consent from patient, if pt unconscious than take consent from pt attendant and explained them why the procedure is best for the patients and also explained about risk of Infection, bleeding (arterial puncture, haematoma, haemothorax), pain, failure, damage to surrounding structures (including pneumothorax), thrombosis.
o After that Set up sterile trolley
o Than Position the patient with head down if they can tolerate it or head facing away from side of insertion
o After that Identify area of anatomy, where you going to perform.

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Procedure for central line (central venous catheter) insertion

o After that Wash your hands and don sterile gown and gloves than
o Clean the area and apply sterile field. Make sure to have some spare gauze swabs ready.
o Apply sterile sheath than
o Confirm anatomy
o After that insert lignocaine cutaneously, subcutaneously and around internal jugular.
o lignocaine has take time to work, In b/w flush all lumens of the line and then clamp all lumens except the red one where guidewire coming out.
o Ensure caps are available for the lumens.
After that needle attached to syringe and Insert the needle at the apex of the angle formed by the two heads of the sternocleidomastoid, lateral to the carotid artery pulsation, at an angle approximately 30 degrees from the skin. Direct the needle towards the ipsilateral nipple. Blood is usually aspirated within 2.5 cm of insertion. If blood is not aspirated while advancing, slowly withdraw the needle. Aspiration often occurs as the needle is pulled back.
o When blood is freely aspirated remove syringe and immediately inset J shape guidewire. This wire should pass easily , After that
o Keeping hold of the inserted wire and remove the needle. Make sure the wire stays in the vein as you do this
o After that Use scalpel to make an small incision in the skin (approx 3mm). This should be done cutting away from the wire so that not to damage it
o Than Pass the dilator over the wire and gently but firmly dilate a tract through to the internal jugular vein.
o At this stage there may be some bleeding so ensure to have some swabs ready
o Remove the dilator and pass the central line over the guide wire. Do not insert the whole tube until you have hold of the end of the wire.
o Once the central line is in place than remove the wire
o After that Aspirate and flush all lumens and re clamp and apply lumen caps
o Than Suture the line to allow 4 points of fixation
o Dress with a clear dressing so the insertion point can be clearly seen

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Post-procedure
o Attach central line to pressure bag to allow CVP monitoring
o Take a blood sample for ABG to ensure a venous sample
o Take Chest x-ray to confirm the placement of central line and to check for pneumothorax
o And finally note down a Clear documentation of date of insertion and monitor for infection

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skpsubodh10@gmail.com

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