How Do You Place a Central Line With Ultrasound Guidance?

Medically Reviewed on 5/18/2022
How Do You Place a Central Line With Ultrasound Guidance
Learn about how a central line placement is done under ultrasound guidance

Central line placement under ultrasound guidance helps with more accurate placement of a central venous catheter while lowering the risk of associated complications. Ultrasound guidance helps provide accurate anatomy of the site where the catheter is to be placed and thus results in fewer puncture attempts.

During an ultrasound-guided central line placement, the following steps may occur:

  • Pain medications and sedatives are administered.
  • The patient lies on the couch with the head slightly lowered for better exposure of the neck structures (for placing a central line in the blood vessels of the neck).
  • The doctor stands at the head end of the patient and cleans the neck with an antiseptic solution.
  • The cannulation site is numbed using a local anesthetic.
  • The ultrasound probe is used to obtain images of the neck vessels and other important structures in the neck.
  • After identifying the blood vessel to be cannulated, the doctor inserts a needle into the skin to create a small tunnel.
  • Then, the central line is placed in the tunnel so that the tip of the catheter rests in a large vein.
  • The catheter is secured in place using sterile dressing at the entry site.
  • The patient’s vitals are monitored in the recovery room.
  • The patient may be discharged on the same day if it is an outpatient procedure, but someone needs to drive them home.

What is a central line?

A central line or central venous catheter (CVC) is a thin, flexible tube that is placed in a large vein for diagnostic or treatment purposes. It is typically placed in the large veins of the neck, chest, arm, or groin to administer fluids or medications or withdraw blood for diagnostic purposes. 

A central line is particularly helpful when access to the vein is needed for long-time kidney dialysis or treatment. It can be used to provide nutrition (parenteral nutrition) to patients who cannot be fed by mouth. This saves time and prevents repeated discomfort from frequent needle pricks.

Unlike standard intravenous routes, where a small catheter is used to administer medications into a vein near the skin’s surface for shorter periods of time, a central line uses a longer catheter that empties in or near the heart and can be left in place for weeks or months. A central line may be used in intensive care unit (ICU) settings, long-term care facilities, outpatient care (such as in dialysis centers), or for at-home care of patients with certain chronic or serious illnesses (such as cancer).

What are possible risks of central line placement?

Because central lines are placed in a large vein and for longer durations, they generally carry more risks than a standard intravenous (IV) line. The doctor decides whether to place the line depending on the benefits of placing the line in comparison with the associated risks.

Some of the risks of a central line include the following:

  • Infection
  • Air embolism (blockage of an artery or a vein due to entry of one or more air bubbles)
  • Pneumothorax (presence of air between the lungs and the chest wall)
  • Arrhythmia (abnormal heart rhythm)
  • Blood vessel injury
  • Nerve injury
  • Catheter misplacement or malposition
  • Subcutaneous hematoma (collection of blood under the skin)
  • Hemothorax (collection of blood in the space between the lung and chest wall)
  • Cardiac arrest (in fewer than 1% of cases)

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Medically Reviewed on 5/18/2022
References
Image Source: iStock Image

Young MP, Yuo TH. Overview of complications of central venous catheters and their prevention in adults. UpToDate. https://www.uptodate.com/contents/overview-of-complications-of-central-venous-catheters-and-their-prevention-in-adults

Centers for Disease Control and Prevention. Frequently Asked Questions about Catheters. https://www.cdc.gov/hai/bsi/catheter_faqs.html

Johns Hopkins Medicine. Central Line Placement. https://www.hopkinsmedicine.org/interventional-radiology/procedures/clp/