Explain the procedure and ask for patient's consent

Positioning

Place patient on monitoring including ECG

Identify the Vein

Using ultrasound or landmarks

Prepare Sterile Field

Open all required sterile equipment onto field

Don cap and mask

Scrub then don sterile gown and gloves

Prepare the Site

Decontaminate a large area with chlorhexidine

Place the Drape

Expose the decontaminated site and cover everything else

Prepare Equipment

Draw up local, place everything in the order it will be used

Prepare the PICC Line

Place bungs on all lumens except central lumen, flush each lumen

Place sterile probe cover onto ultrasound probe with gel

Reidentify the Vein

Using ultrasound or landmarks

Inject Local Anaesthetic

Create a small wheal over the insertion site

If the needle or catheter must be removed at any time, place pressure on the insertion site in order to prevent haematoma formation.

Remove the Needle

While holding onto guidewire, apply pressure to site using gauze

Make an Incision

Using the scalpel, make a small incision adjacent to the guidewire

Use the Dilator

While holding the guidewire, insert dilator just into the vein and then remove it, placing pressure with gauze

Remove the Guidewire

Aspirate then flush each lumen with saline

Suture the Catheter

Fix in place at one or two points

Dress the Site

Using sterile, transparent occlusive dressing

Document

Confirm the CVC Position

Internal jugular and subclavian catheters

Using chest x-ray

Pneumothorax / Haemothorax

Most commonly with subclavian catheters

Air Embolism