Main Page

Central Venous Catheter Insertion

Central Venous Catheter Insertion Learning Module

This website is composed of five sections designed to re-familiarize practitioners with central venous

Print all the necessary documents here or at other points throughout the module.
*Note: This module does not replace medical training and must be used in conjunction with clinical judgment. Acting practitioner is ultimately responsible for the safety of procedures.

Normal saline flush

1% lidocaine without epineprhine

SoluPrep Sterile Swabs

Sterile Gauze

Sterile Gloves

REF 8605

Principle Risks

  • Arterial puncture3%
  • Pneumothorax or hemothorax<0.1 to 0.2%
  • Cardiac arrhythmia
  • Air embolism
  • Thoracic duct injury
  • Catheter malposition

Rare Risks

  • Infection (rate per 1000 catheter days)8.6%
  • Venous thrombosis (rate per 1000 catheter days)1.2-3%
  • Catheter migration
  • Catheter embolization
  • Myocardial perforation
  • Nerve injury
  • Print Consent Form


  • Infection of area overlying the target vein
  • Thrombosis of target vein
  • Presence of existing indwelling hardware such as hemodialysis line or pacemaker
  • Vascular injury proximal to insertion site


  • Coagulopathy – Consider plasma based products to correct coagulopathy although little evidence exists to support this.
  • Thrombocytopenia – Consider platelet transfusion to improve degree of thrombocytopenia although little evidence exists to support this.

Contraindications to central venous catheter insertion are relative and depend on the urgency for vascular access

Print Procedure Note

1Preparation and Patient Position

  • Place patient in 10-15 degree trendelenburg position to increase size of internal jugular vein and to decrease risk of air embolism
  • Turn head slightly from side of planned catheter insertion
  • When possible, choose the right internal jugular vein to reduce risk of complications.
    • The right internal jugular vein has a straight course to the superior vena cava and the dome of the right lung is lower than the left.
  • Locate internal jugular vein typically between the two heads of the sternocleidomastoid and lateral to carotid artery


  • Use high frequency linear array probe to visualize internal jugular vein relative to carotid artery.
  • Distinguish between internal jugular vein and artery by applying gentle pressure with ultrasound probe. The internal jugular vein is compressible; the artery is non-compressible and pulsatile
    • To minimize risk of arterial puncture, ensure artery is not posterior to vein at catheter insertion site.

3Sterilizing, Draping and Preparing Catheter

  • Dress with sterile gown, mask, cap and gloves
  • Apply sterile drape over patient
  • Place sterile cover over US probe
  • Sterilize catheter insertion area 3 times using antiseptic swabs

4Prepare Equipment

  • Flush lumens
  • Ensure guidewire can be inserted into lumen.

5Central Venous Catheter insertion by Seldinger Technique

Anaesthetize area
  • Using 25 gauge needle, inject “wheel” of lidocaine with into dermis overlying prospective needle insertion site
Needle insertion
  • Position introducer needle at 45 degrees to patient’s neck and direct towards patient’s ipsilateral nipple
  • Using ultrasound follow needle tip during puncture of skin, subcutaneous tissue and vein.
  • Advance needle while applying gentle suction to syringe
    • The needle has entered the vein when flash back of venous blood enters syringe.
  • Hold needle in place, remove syringe and advance guide wire through needle ensuring 10-15cm of wire enters the vessel.
    • The guidewire should advance with little resistance.
  • Once guidewire is inserted, hold wire at entry point on skin and remove needle
Catheter insertion
  • Create small nick in skin and subcutaneous tissue with scalpel where dilator and catheter will be inserted
  • Insert dilator 2 cm by applying gentle pressure and twisting movement
  • Remove dilator and stabilize wire at skin insertion site.
  • Insert catheter device over wire.
  • Withdraw wire until tip is visualized at the proximal lumen of catheter.
  • Insert catheter over wire using rotating motion until distal tip is at junction between the superior vena cava and right atrium.
  • Remove guidewire
  • Check for blood return in all ports
  • Flush all ports
  • Secure catheter with sutures and dressing

6Post Catheter Insertion Care

  • Confirm position with chest xray
  • Complete procedure note in chart


Artery puncture:

Confirm by observing for bright red, pulsatile blood from needle hub. If present, do not insert guidewire. Apply pressure to bleeding site.


Suspect pneumothorax if air is aspirated from central venous catheter port and patient is in respiratory distress. Perform urgent chest xray to confirm and treat accordingly

Persistent bleeding:

Apply pressure to site. Replace blood products as required.

Cardiac arrhythmias:

Pull back on the wire or catheter as it may be in heart.
Skip to toolbar