•Indication: Inability to obtain peripheral access, centrally administered drugs (ie. Pressors), CVP monitoring, Swan-Ganz catheter placement.

•Equipment: betadine, lidocaine, sterile towels, central line kit which includes needle w/ syringe, guidewire, scalpel, dilator, and triple lumen catheter

•Technique: Position (varies depending upon site of access), prep and drape pt.  Infiltrate skin overlying site of access.  Insert needle and syringe, advance slowly while aspirating.  Once dark blood easily entering syringe, carefully unscrew syringe from needle.  Using Seldinger technique, pass guidewire through needle, taking care to always have one hand on the guidewire.  Remove needle, then using scalpel, make small incision at skin under guidewire.  Then pass dilator over guidewire until tract made through subcutaneous tissue under skin.  Remove dilator, then thread triple lumen catheter thru guidewire into vein.  Now remove guidewire, secure catheter with suture, apply dressing.  Catheter is ideally flushed prior to use, but now aspirate small amount of blood from each of the three ports to again confirm intravenous placement, then flush with saline.

•Complications: bleeding, infection