Here are some resources that I’ve found useful.

1. How to scrub. This is often done badly in ED – there’s no excuse for this. Please make sure that the insertion site, the patient and the bed are all covered by drapes.
2. Blind insertion. This is not recommended. There is a ton of evidence supporting the use of ultrasound.
3. Ultrasound-guided insertion:
   • The evidence
   • IJV, SCV and femoral vein approaches
   • transverse, longitudinal and oblique techniques
4. How to confirm line placement and avoid complications.
5. Using an angiocath instead of the needle to avoid inadvertent displacement outside of the lumen of the vein.
6. Where should the tip sit?
7. Setting up the transducer.
8. Which ports to use?:
   • distal port (usu ~ 16-gauge lumen): the largest lumen; used for CVP monitoring, emergency access, blood products
   • medial and distal port (smaller lumens, more chance of extravasation): used for everything else
   • don’t run anything else with inotropes/pressor
   • radiocontrast media (RCM) – CAN go through the CVC – any port ≥ 18-gauge – check CVC type and max flow rate; discuss with radiology

After all of this, you should be a line guru!

Thanks,

Stacy