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Central Line - Seldinger Technique

Views: 11189 - Comments: 15

Meredith Rose, CVT, VTS(ECC), talks Joanie Abrams, CVT, VTS(ECC), through her first central line placement. Patient prep, placement, confirmation, and care are discussed.

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Meredith Rose's picture
Meredith Rose

CVT VTS(ECC)

Enrolled: 08/2011

Joanie Abrams's picture
Joanie Abrams

CVT VTS(ECC)

Enrolled: 08/2011

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Comments

Katharine Haughton's picture

Great video! Very clear and good explanations behind the reasoning of each aspect of placement and catheter care.

Kathleen Depaolo's picture

Meredith did a great job explaining this process. Very easy to understand, a great video I will use today to show my students!

Nicole Bernardi's picture

Wow, great video!!! Now we just need a video this clear and detailed about IO catheter placement! :)

Mallory Leake's picture

This was a very helpful video. It made the process seem a little less daunting.

Cesar Abasolo's picture

Great video! I actually performed this exact technique shortly after watching this video. I Manage and Supervise the ER Dept. at a Animal Specialty Hospital in San Diego CA, and all these training videos have been very beneficial to my staff.

Aria Guarino's picture

Hi Meredith! Thanks for the informative video. If we do not have Tregaderm at our clinic, should we use a Telfa pad instead?

Joanie Abrams's picture

Hi Aria! If you don't have Tegaderm a Telfa pad is a fine replacement. You would just follow the same bandaging advice and assess the insertion site, replacing the Telfa, once a day.

Jessica Parry's picture

This was really helpful. 2 questions- do you have any tips for measuring the length of the catheter prior to placement to help determine what catheter you are going to open? Do you measure to the 2nd intercostal space? Also, what are your thoughts about monitoring ECG during placement to look for arrhythmias?

Chris Green's picture

Hi Jessica,

Great question! After speaking with various CVTs here at DoveLewis, everyone agreed that the size and length of the catheter are almost always determined by the number of ports desired or the lumen size needed for the patient. When measuring the best location is to measure to the caudal edge of the triceps muscle. This information can be found in the Silverstein / Hopper - Small Animal Critical Care Medicine book. Lastly, when it comes to monitoring, I'm always in favor of it! It really helps to have an ECG when you are placing it to know if you have inserted too far and to watch for arrhythmias as well. Let me know if you have any other questions, I'm glad the video was helpful!

Liza Morales RVT's picture

How do you determine what gauge central line to place in the patient? And also, do you measure before placement? I always take a radiograph post, but I have attending that recommend measuring for placement prior. What guidelines would you recommend?

Sarah Harris's picture

Hi Liza. I choose the size central venous catheter (CVC) that I feel can fit the patient. This choice gets easier with more experience. My general guidelines are 4-5.5fr CVC for cats/small dogs, 5.5-7fr for medium-large dogs, and 8.5fr or larger for large-giant breed dogs. Things like anatomy, hydration status, and therapeutic goals can impact your decisions as well. Go up or down a size as needed. The larger CVCs come with more lumens, so sometimes this impacts my decision. Example: I may very easily be able to get a 4fr double lumen into a 6kg cat, but I may want to try a 5.5fr triple lumen because I think that extra port could be beneficial for future therapies. I do always measure prior to placement. Our goal is to terminate the CVC in the thoracic vena cava just cranial to the right atrium. I measure to the 3-4 rib space and adjust as needed. Proper placement allows the CVC to be used for polypharmacy, administration of hyperosmolar dogs, blood sampling, and central venous pressures (CVP). While CVPs are falling out of favor in emergency medicine it does tell us end diastolic volume where there is maximum stretch and filling of the heart. This can be a great trend to monitor when we are concerned about volume overload in hospitalized patients. A single lateral thoracic image is adequate to confirm appropriate placement. Make adjustments as needed. Remember you can only back the catheter out (not advance further), once your guide wire is removed and sterility has been broken. Thanks for the excellent questions!