Print Friendly, PDF & Email

Central line (central venous catheter) insertion

­­Central line insertion should be real-time ultrasound guided. The internal jugular is usually preferred to subclavian approach where possible as it is less likely to lead to pneumothorax

Indications for central line (central venous catheter) insertion

  • Administration of medications that require central access e.g. amiodarone, inotropes, high concentration electrolytes
  • Fluid balance monitoring with CVP
  • Intravenous access (long term or difficult peripherally)


Complications of central line (central venous catheter) insertion

  • Haemothorax
  • Pneumothorax
  • Haematoma
  • Inadvertent arterial puncture

 Equipment required for central line (central venous catheter) insertion

  • Ultrasound and sterile ultrasound sheath
  • Sterile trolley
  • Sterile field, gloves, gown and mask
  • Seldinger central line kit
  • Saline flush
  • Chlorhexidine
  • Lignocaine (4ml (2 vials) of 2% is reasonable)
  • Suture
  • Scalpel
  • Sterile dressing
  • Pressure bag to attach to monitoring

 Contraindications to central line (central venous catheter) insertion

  • Coagulopathy
  • Local infection
  • Avoid in raised intracranial pressure- aim for a femoral approach if required
  • Patient non-compliance


  • Consent patient if conscious otherwise document why the procedure is in the patients best interests
  • Consent should include:
    • Infection, bleeding (arterial puncture, haematoma, haemothorax), pain, failure, damage to surrounding structres (including pneumothorax), thrombosis.
  • Set up sterile trolley
  • Position patient with head down if they can tolerate it, with head facing away from side of insertion
    • This ensures maximum venous filling
  • Ultrasound area to define anatomy
  • Having a nurse or assistant is helpful

 Procedure for central line (central venous catheter) insertion

  • Wash hands and don sterile gown and gloves
  • Clean the area and apply sterile field. Make sure to have some spare gauze swabs ready.
  • Apply sterile sheath to the ultrasound probe
  • Confirm anatomy
  • Under ultrasound guidance insert lignocaine cutaneously, subcutaneously and around internal jugular.
  • Whilst lignocaine has time to work flush all lumens of the line and then clamp all lumens except the Seldinger port
  • Ensure caps are available for the lumens
  • Under ultrasound guidance take Seldinger needle attached to syringe and insert into the internal jugular vein
  • When blood is freely aspirated remove syringe and immediately inset Seldinger wire. This should pass easily
  • Keeping hold of the inserted wire, remove the needle. Ensure the wire stays in the vein as you do this
  • Use scalpel to make an small incision in the skin (approx 3mm). This should be done cutting away from the wire so as not to damage it
  • Pass the dilator over the wire and gently but firmly dilate a tract through to the internal jugular.
    • At this stage there may be some bleeding so ensure to have some swabs ready
  • Remove the dilator and pass the central line over the Seldinger wire. Do not advance the line until you have hold of the end of the wire
  • Once the central line is in place, remove the wire
  • Aspirate and flush all lumens and re clamp and apply lumen caps
  • Suture the line to allow 4 points of fixation
  • Dress with a clear dressing so the insertion point can be clearly seen




  • Attach central line to pressure bag to allow CVP monitoring
    • Nursing staff can show you how to do this or will do it for you
  • Run a blood gas to ensure a venous sample
  • Chest x-ray to confirm placement and to check for pneumothorax
  • Clear documentation of date of insertion and monitor for infection

 In the event of failure

  • Stop procedure
  • Seek senior help

 Top Tips for central line (central venous catheter) insertion

  • Central lines can have multiple lumens. Most commonly 3,4 and 5 lumen lines are inserted. Confirm what the line will be used for and how many infusions a patient has to aid your selection of the line with the correct amount of lumens
  • Always ensure you are happy with your anatomy before commencing the procedure
  • Ensure your sterile trolley is well set up with the kit lined up in the order you will use things and a clear area for sharps. This will make your life easier.



Click here to download free teaching notes on central line (central venous catheter) insertion: Procedures – Central line insertion

Perfect revision for medical students, finals, OSCEs and MRCP PACES