Central Line Insertion
Outside of very rare emergency circumstances, all of our internal jugular and femoral central line placements are done under ultrasound guidance. The links to the videos below will provide you with an overview of the procedure and common troubleshooting issues. If you are rotating at TGH, there are special considerations when placing central lines for patients on ECMO. Please speak to the attending before proceeding with central venous access for these patients.
- Ultrasound-Guided Access: This is an excellent introductory video to accessing vessels safely using ultrasound.
- Easy Central Line Placement: Very helpful step-by-step walkthrough for insertion of an IJ central line. The only caveat is that they don’t show the removal of the guidewire after the line is inserted..DO NOT FORGET THIS STEP.
Arterial Line Insertion
Every ICU has slightly different equipment for arterial line insertion. In the TGH, TWH, and Sinai ICUs most people use a 20G (pink) angio catheter +/- a guidewire for radial arterial lines. There are also radial arterial line kits with a built-in guidewire if you prefer this approach. There are dedicated kits for femoral arterial lines.
- Arterial Line Insertion: Both direct insertion and use of a guidewire are demonstrated.
- Ultrasound-Guided Arterial Line Insertion: This technique can also be adapted to incorporate use of a guidewire.