1. Ultrasound Central Line

3.  Most providers no longer use landmarks for central line placement except for with subclavian lines and occasionally femoral lines  Increased accuracy  Increased efficiency  Ability to confirm placement in real time

7.  Trendelenburg positioning  Phythagorean theorem

8.  The Site Rite or the Zonare US machines  Sterile US probe Cover  Sterile Gloves  Betadine/Chlorhexidine  Sterile saline/ Blue caps  Central Line Kit  Should have everything else you need  A nurse ready to help if you need anything else

9.  Still use the Seldinger technique  Needle  Wire  remove needle  Small incision at skin  dilator  back thread the wire through the triple lumen  Remove wire  suture in place  Never let go of the wire  Difference is you can use the US to see the vein and vein puncture  http://www.youtube.com/watch?v=cYzVPMQc3aY&feature= related http://www.youtube.com/watch?v=cYzVPMQc3aY&feature= related

13.  Failure to identify the needle in the tissue.  Failure to distinguish between vein and artery.  Angling the transducer towards the entry site of the needle on the skin may help visualize the needle earlier.  Avoid advancing the catheter if the needle tip is not visualized.  Trendelenburg position, Valsalva Maneuver,  Use caution when utilizing a long axis approach to central venous cannulation due to the inability to maintain visualization of the carotid artery at all times.  Sterile US gel