Six-step approach to ultrasound-guided central venous ...
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Six-step approach to ultrasound-guided central venous catheter placement



I. Identify anatomy of insertion site and localization of the vein

• Identify vein, artery, anatomic structures

• Check for anatomic variations

• Use short axis (transverse; A) and longaxis (longitudinal; B) view

• Perform this step before prepping and draping of the puncture site



II. Confirm patency of the vein

• Use compression ultrasound to exclude venous thrombosis

• Use color Doppler imaging and Doppler flow measurements to confirm the patency of the vein and to quantify blood flow 



III. Use real-time US guidance for puncture of the vein

• Use an aseptic approach

• Use a short axis/out-of-plane (A) or a long axis/in-plane (B) approach

• Try to constantly identify the tip of the needle during the needle approach to the vein and puncture of the vein



IV. Confirm needle position in vein

• Confirm that the needle tip is placed centrally in the vein before approaching the

guide wire 



V. Confirm wire position in vein

• Confirm the correct position of the guide wire in a short axis (A) and a long axis (B) view



VI. Confirm catheter position in vein

• Confirm the correct position of the central venous catheter in the vein in a short axis

(A) and a long axis (B) view 



#CentralLine #Ultrasound #Guided #POCUS #Placement #Catheter #Venous #Management #CriticalCare
Contributed by

Eddy Joe MD
@eddyjoemd
Educator and Intensivist - https://www.eddyjoemd.com
Host of the Saving Lives Podcast - https://anchor.fm/eddyjoemd
I teach Critical Care Medicine on YouTube & Instagram - https://www.youtube.com/EDDYJOEMD | https://www.instagram.com/eddyjoemd/ | https://twitter.com/eddyjoemd
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