Find the central vein as described in the previous section. Cannulate the central vein using the same technique employed for a peripheral vein cannulation. Due to the relatively short length of the cannula, this technique works best for superficial central vein cannulation (eg. EJV or IJV cannulation).
Catheter over guidewire (Seldinger Technique)
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 Seldinger
Technique |
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Photographs - Triple lumen CVP |
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Video
Demonstration |
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Animation |
Complications of central line insertion
Complications during insertion |
Late complications |
Arterial puncture |
Infection |
Pneumothorax |
- local |
Cardiac dysrhythmias |
- systemic |
Bleeding, haematoma, haemothorax |
- endocarditis |
Damage to thoracic duct, chylothorax |
Thrombosis, thromboembolism |
Nerve injury |
Cardiac dysrhythmias |
Air emboli |
Cardiac perforation and tamponade |
Catheter shearing +/- fragment embolisation |
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Malplacement |
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Airway obstruction (rare – may be due to large bilateral haematoma) |
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How to remove a central venous catheter ?
Wash hands and wear gloves. Remove the external dressing and any sutures holding the catheter in place. The catheter should be removed during exhalation (the patient's not yours!!). Ask the patient to hold their breath in the exhalation phase and remove the catheter with a slow and steady pull. Cover with a sterile dressing and apply firm pressure to the site for at least 5 minutes until any bleeding stops.
The catheter should come out smoothly without requiring excessive force. If it cannot be easily removed try twisting the catheter while pulling it gently out. If this also fails cover the site with a sterile dressing and seek help.