Central Line Placement: Best Practices and Technique

Preparation and Equipment

The American Society of Anesthesiologists recommends using real-time ultrasound guidance for central venous catheter placement, particularly for the internal jugular vein, to reduce complications and increase safety 1, 2
The American Society of Anesthesiologists suggests gathering necessary equipment including sterile drapes, personal protective equipment, ultrasound machine with high-frequency linear probe, sterile ultrasound probe cover, sterile gel, and central venous catheter kit 3
The American Society of Anesthesiologists advises using a standardized equipment set and following a checklist or protocol for central line placement 4

The American Society of Anesthesiologists recommends positioning the patient in the Trendelenburg position for internal jugular or subclavian approach to increase venous filling 1, 5
The American Society of Anesthesiologists suggests minimizing head rotation during internal jugular vein access to reduce arterial-venous overlap 5

The Society of Critical Care Medicine recommends using ultrasound to identify the target vein, adjacent artery, and surrounding anatomic structures 2, 6
The Society of Critical Care Medicine advises checking for anatomic variations, which occur in a significant proportion of patients 6, 3
The Society of Critical Care Medicine suggests using both short-axis and long-axis views of the vessels 2, 6

The American Society of Anesthesiologists recommends using a thin-wall needle technique rather than catheter-over-needle technique for subclavian approach 1, 8
The American Society of Anesthesiologists advises selecting either thin-wall needle or catheter-over-needle technique based on clinical situation and operator experience for internal jugular or femoral approach 1, 8

The American Society of Anesthesiologists recommends leaving the catheter in place and consulting a vascular surgeon or interventional radiologist immediately if unintended arterial cannulation with a large-bore catheter occurs 4
The American Society of Anesthesiologists advises ordering chest radiography to check for wire retention in the vascular system if the complete guidewire cannot be located in the procedural field 1, 8

The Society of Critical Care Medicine warns that relying solely on anatomic landmarks without ultrasound guidance increases complication risk, especially with anatomic variations 2, 6
The American Society of Anesthesiologists advises verifying venous placement with ultrasound, manometry, or pressure waveform to avoid arterial dilation/cannulation 1, 8