Six-step approach to ultrasound-guided central venous catheter placement I. Identify anatomy of insertion site and localization of the vein • Identify vein, artery, anatomic structures • Check for anatomic variations • Use short axis (transverse; A) and longaxis (longitudinal; B) view • Perform this step before prepping and draping of the puncture site II. Confirm patency of the vein • Use compression ultrasound to exclude venous thrombosis • Use color Doppler imaging and Doppler flow measurements to confirm the patency of the vein and to quantify blood flow III. Use real-time US guidance for puncture of the vein • Use an aseptic approach • Use a short axis/out-of-plane (A) or a long axis/in-plane (B) approach • Try to constantly identify the tip of the needle during the needle approach to the vein and puncture of the vein IV. Confirm needle position in vein • Confirm that the needle tip is placed centrally in the vein before approaching the guide wire V. Confirm wire position in vein • Confirm the correct position of the guide wire in a short axis (A) and a long axis (B) view VI. Confirm catheter position in vein • Confirm the correct position of the central venous catheter in the vein in a short axis (A) and a long axis (B) view #CentralLine #Ultrasound #Guided #POCUS #Placement #Catheter #Venous #Management #CriticalCare
