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| (i) Do use to gain peripheral venous access, deliver substances not safely given via peripheral IV access, hemodialysis, plasmapheresis, measurement of cardiac filling pressures, placement of pulmonary artery catheter, placement of trans venous pacer and access for frequent blood sampling. | |
| (ii) Do not use if operator inexperienced, uncooperative patients and uncorrected coagulopathy. | |
| (iii) Do not use or use with caution in cellulitis/infected at anticipated insertion site, previous surgery/injury SVC, severe respiratory disease that cannot tolerate a pneumothorax (consider femoral route), when adequate peripheral access is available, vasculitis, congenital heart disease, presence of cardiac pacemaker and or other intracardiac devices. | |
| (iv) Do get informed consent for elective placement. In an emergency, do document the need in records. | |
| (v) Do make sure all materials are within reach before the commencing the procedure. | |
| (vi) Do use sterile precautions to reduce infective complications. | |
| (vii) Do use ultrasound guidance as it reduces the failure rate, especially for cannulation of the internal jugular vein. | |
| (viii) Do leave dilator in situ if you have entered an artery and call vascular surgeon. | |
| (ix) Do use large-bore catheters if rapid volume deliver is required. | |
| (x) Do remember that right internal placement with ultrasound guidance has a lower risk of pneumothorax than subclavian line placement. | |
| (xi) Do remember that central line placement in the femoral veins carries a higher risk of thrombotic and infectious complications. | |
| (xii) Do remember that there is a higher risk of air embolism in patients spontaneously breathing with large negative intrathoracic pressures, low CVP. | |
| (xiii) Do remember that arrhythmias are related to malpositioned catheter tip within right atrium or ventricle, and it resolves with pulling back of guidewire or catheter. | |
| (xiv) Do minimize thrombotic complications by ensuring that the catheter tip is located centrally within the distal third of the SVC or at the cavoatrial junction. | |
| (xv) Do prevent guidewire embolization. Keep your hand on the wire when possible and never loose site of the guidewire during the insertion process. | |
| (xvi) Do remember that incidence of arterial puncture is higher in pulseless patients, and remember veins are compressible. | |
| (xvii) Do obtain a chest X-ray following the procedure, even if unsuccessful line. | |
| (xviii) Do check the chest X-ray for line tip placement, pneumothorax, and hemothorax. | |
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