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ICU Knowledge Map · Procedure checklist

Ultrasound-Guided Central Venous Catheter Insertion

Educational checklist. Use local policy, institutional credentialing and patient-specific clinical judgment. This sheet does not replace the full audited procedure guide.

Patient: __________________
Date: __________
Operator: ______________
Supervisor: ______________

BEFORE

  • ☐Indication confirmed and alternative strategy considered.
  • ☐Contraindications / reasons to change strategy reviewed.
  • ☐Consent or emergency justification documented as appropriate.
  • ☐Team roles, time-out, rescue plan and required monitoring confirmed.
  • ☐Equipment complete and immediately available.
  • ☐Choose the site by balancing infection, mechanical-complication, thrombosis, bleeding and future dialysis-access risks. In adults, CDC guidance advises avoiding femoral CVC access when suitable alternatives exist; for a nontunneled CVC, subclavian access has lower infection risk than jugular/femoral access but must be balanced against pneumothorax/bleeding risk.
  • ☐Avoid subclavian access in hemodialysis patients and patients with advanced kidney disease when possible because central venous stenosis can compromise future permanent dialysis access.
  • ☐Use the minimum number of catheter lumens required for the clinical indication.
  • ☐Perform hand hygiene and maximal sterile barrier precautions: cap, mask, sterile gown, sterile gloves and a full-body sterile drape.
  • ☐Prepare clean skin with >0.5% chlorhexidine in alcohol unless contraindicated, and allow the antiseptic to dry according to the product instructions before puncture.
  • ☐Flush and prepare all lumens, caps and clamps before insertion.
  • ☐For adults undergoing CVC placement at a compressible site, the 2025 AABB/ICTMG platelet guideline recommends prophylactic platelet transfusion when the platelet count is <10 × 10^3/µL (conditional recommendation). Do not extrapolate this single threshold to noncompressible, large-bore or otherwise higher-risk access; individualize with the procedural context and local policy.

DURING — ORDERED TECHNIQUE

  1. 1.☐ Identify vein and artery with ultrasound and confirm patency
  2. 2.☐ Infiltrate local anesthetic
  3. 3.☐ Advance needle under real-time ultrasound until tip is clearly in the vein
  4. 4.☐ Confirm venous blood/pressure when uncertainty exists
  5. 5.☐ Advance guidewire without force and visualize it in the vessel
  6. 6.☐ Make a small skin nick, then dilate only after wire position is certain
  7. 7.☐ Advance catheter over the wire while maintaining control of the wire at all times
  8. 8.☐ Remove wire, aspirate and flush every lumen
  9. 9.☐ Secure catheter, apply sterile dressing and document depth

CONFIRM SUCCESS

  • ☐Confirm venous placement before dilation when doubt exists
  • ☐Confirm final catheter tip/absence of pneumothorax using the locally accepted method: ultrasound, intracavitary ECG and/or chest radiography depending on site and circumstances
  • ☐Do not use for high-risk infusion if location remains uncertain

AFTER

  • ☐Daily line-necessity review
  • ☐Inspect site and dressing
  • ☐Use meticulous hub disinfection
  • ☐Remove promptly when no longer required

HARD STOPS / ESCALATE

  • ☐Never dilate without confident venous wire position
  • ☐Stop if resistance is encountered
  • ☐Treat sudden hypoxemia/hypotension after thoracic insertion as a possible procedural complication until excluded
Generated from the ICU Knowledge Map audited procedure guide. Confirm local policy and current institutional protocol before clinical use.