Choice of Technique

Find the central vein as described in the previous section. Cannulate the central vein using the same technique employed for a peripheral vein cannulation. Due to the relatively short length of the cannula, this technique works best for superficial central vein cannulation (eg. EJV or IJV cannulation).

Catheter over guidewire (Seldinger Technique)

Complications of central line insertion

Complications during insertion
Late complications

Arterial puncture

Infection

Pneumothorax

- local

Cardiac dysrhythmias

- systemic

Bleeding, haematoma, haemothorax

- endocarditis

Damage to thoracic duct, chylothorax

Thrombosis, thromboembolism

Nerve injury

Cardiac dysrhythmias

Air emboli

Cardiac perforation and tamponade

Catheter shearing +/- fragment embolisation

 

Malplacement

 

Airway obstruction (rare – may be due to large bilateral haematoma)

 

How to remove a central venous catheter ?

Wash hands and wear gloves. Remove the external dressing and any sutures holding the catheter in place. The catheter should be removed during exhalation (the patient's not yours!!). Ask the patient to hold their breath in the exhalation phase and remove the catheter with a slow and steady pull. Cover with a sterile dressing and apply firm pressure to the site for at least 5 minutes until any bleeding stops.

The catheter should come out smoothly without requiring excessive force. If it cannot be easily removed try twisting the catheter while pulling it gently out. If this also fails cover the site with a sterile dressing and seek help.