Quick Reference Guide
Quick Reference Guide
Completion requirements
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Quick Reference Guide
Central venous access on one page
The steps, numbers and red flags to know before the day.
| Topic | Key facts | Source |
|---|---|---|
| Ultrasound | Recommended for IJV insertion and for other central sites. Scan before you choose and keep the needle tip in view | NICE TA49; AAGBI 2016 |
| Vein or artery | Vein compresses, is not pulsatile and grows head-down; artery stays round and pulsatile | AAGBI 2016 |
| Position | Head-down for neck and chest sites; flat for femoral | AAGBI 2016 |
| Asepsis | Cap, mask, sterile gown and gloves, large drape; 2% chlorhexidine in 70% alcohol, allowed to dry; sterile probe cover | epic3 |
| Checklist | LocSSIP: sign in, time out, sign out. Count the wire out intact | NatSSIPs 2 |
| Guidewire | Never let go; never force; not beyond 20 cm without imaging; withdraw if ectopics | AAGBI 2016 |
| Before dilating | See the wire inside the vein on ultrasound | AAGBI 2016 |
| Artery cannulated | Leave devices of 6 Fr or larger in place; urgent vascular or radiology advice | AAGBI 2016 |
| Tip position | Lower SVC or upper right atrium, parallel to the wall. Confirm as per trust policy | AAGBI 2016 |
| After insertion | Review daily; remove when not needed; remove head-down with breath-hold | epic3; AAGBI 2016 |
Red flags: stop and get help
- Pulsatile or bright blood from the needle or catheter
- Sudden breathlessness, hypoxia or hypotension (pneumothorax, air embolism)
- A wire that will not advance or come back
- An expanding neck haematoma
Sources for this chapter
- National Institute for Health and Care Excellence. Guidance on the use of ultrasound locating devices for placing central venous catheters (TA49) (2002)
- Bodenham A, Babu S, Bennett J, et al. Association of Anaesthetists of Great Britain and Ireland: Safe vascular access 2016. Anaesthesia 2016;71(5):573–585
- Loveday HP, Wilson JA, Pratt RJ, et al. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014;86(Suppl 1):S1–S70
- Centre for Perioperative Care. National Safety Standards for Invasive Procedures 2 (NatSSIPs 2), 2023. See NHS England: NatSSIPs
These notes support a simulation course. They do not replace your trust's central venous access policy, the manufacturer's instructions for your equipment, or supervised workplace training and sign-off.
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