how to create a CVP line?. . . . . . . . .?

Question

tips to create a fast, successful cvp line (short line). I have attempted 5 so far but only managed to create 2 successfully.

Answer 1

You had done a good job, so far. Constant practice makes it perfect. It is so easy to read on the described procedures but it actually becomes different on the actual practice. Your knowledge,confidence, perseverance and personal "discovery" of your own tactics on establishing a central line would be your best teacher.

Anyway, master your expertise on locating the vein and the accurate spot to be punctured. Note that your finder needle may always not be able to reach the vein. Try to insert the needle bevel up and once the vein is found, rotate the needle 90 degrees so that the bevel is facing caudally.That will ensure easier advancement of the wire.
You may ask an assistant to pull down on the patient's forearm on the ipsilateral side of insertion to further optimize insertion site by separating the shoulder from the clavicle.If using a jugular vein and you hit a bone, march down until just below the clavicle remembering to push down on the needle tip and not on the syringe. Be extra cautious with patients position as well, correct positioning will hasten and facilitate your performance.

Answer 2

1. trendelenberg position- lowering the head helps dilate the jugular vein
2. no pillow under patient's head
3. have patient turn head to contralateral side
4. palpate carotid artery. the internal jugular should be just lateral to the artery.
5. go as distal as you can. try to go below the level of the thyroid cartilidge (adam's apple).
6. if using seldinger technique, you must push the needle in just a few millimeters further after you see the flash of blood. otherwise when you slide the catheter over the needle, it may not go into the lumen. it's better to go all the way through the vessel rather than not go far enough. if you've gone through, just pull out internal needle and withdraw the catheter until you see the blood coming out of it- the catheter tip should be in the vessel lumen then.
7. as mentioned before, using an ultrasound device to guide you may be the best option.

Answer 3

We old farts have always done them blind, but the new wave is to use ultrasound guidance. If you can team with an ultrasonographer for your next few attempts, you'll have a high success rate and gain a bit of experience. After that, the blind ones won't be so bad.