All Central Line
Prepare the equipment
- Use a linear-array transducer.
- Select the venous examination setting.
- Follow appropriate sterile technique according to institutional policy.
Position the patient
- Place the patient supine.
- Turn the head slightly toward the side opposite the insertion site.
- Position the operator at the head of the bed.
Place the transducer
- Position the transducer transversely just below the apex of the sternocleidomastoid muscle triangle.
- Direct the orientation marker toward the operator’s left, at the 9 o’clock position.
Identify the relevant anatomy
- Identify the sternocleidomastoid muscle as the most superficial structure.
- Locate the internal jugular vein deeper to the muscle as an anechoic, elliptical structure that compresses with transducer pressure.
- Identify the carotid artery as an anechoic, circular, pulsatile structure.
- The internal jugular vein should appear superficial to the carotid artery.
- Identify the thyroid gland medial to these structures; it has a light-gray echogenic appearance.
Center the internal jugular vein
- Adjust the transducer until the internal jugular vein is centered in the ultrasound image.
- Confirm the vein’s compressibility and distinguish it from the carotid artery.
Begin needle insertion
- Position the needle just superior to the transducer.
- Slowly advance it adjacent to the transducer’s center line.
- The needle should appear as a small, bright dot on the ultrasound image.
Use the short-axis, dynamic needle-tip technique
- When the needle tip becomes visible, slide the transducer a short distance away until the tip disappears.
- Advance the needle slowly until the tip reappears.
- Repeat this process to ensure that the needle tip remains under direct ultrasound guidance.
Puncture the vein
- Continue advancing slowly until the needle tip is seen indenting and then puncturing the internal jugular vein.
Confirm needle position
- Rotate the transducer 90° to obtain an in-plane, longitudinal view.
- Confirm that the needle tip lies within the midportion of the internal jugular vein.
Proceed according to institutional protocol
- Complete catheter advancement, confirmation, securing, and post-procedure care according to approved local guidelines.
