Learning to do Central Lines

Learning to do Central Lines
5 lumen CVC

Central Venous Catheters (CVCs) or central lines are one of the core procedure all Emergency Medicine doctors should learn to perform.

Most ED Registrars in Australia learn this skill during an ICU rotation and bring it with them to ED from then on. Some who have done an anaesthetic term in a large hospital may learn the skill there too.

While there is no substitute to actually performing a procedure there are many online resources that should serve as a primer for this procedure and I'd recommend watching them before attempting your first CVC, and then re-watch them after the first few to get better at the procedure.

My playlist of the best Central Line videos on YouTube:

My CVC Setup Checklist

  • Central line itself (Power injectable or normal)
  • "Basic ICU pack" - WA Health provides these in ED, ICU, Theatres, etc
  • 20ml of sterile saline
  • ~5ml Lignocaine 1%
  • Chlorhexidine 2% skin prep
  • Positive pressure bungs
    Alternatively can use the bungs from the CVC line OR 3 way taps
  • Stitch - generally a 2-0 silk for hand stitching
  • Large dressing +/- biopatch
  • PPE: Surgical hats, surgical masks - for everyone in the room
  • Sterile gown, sterile gloves
  • Ultrasound machine linear probe
  • Ultrasound probe cover
  • Bluey x2 (floor and patient)
  • Optional:
    Tape to secure patient skin/arm

I go through this checklist in my head before performing the procedure. It can be very frustrating to realise that you've forgotten something after getting your sterile gown and gloves on. Asking other people to get things for you is often unreliable as they don't know exactly what you're referring to.

Ideally in any ED all of these items should all be kept bundled together in a box in the resus room.