ULTRASOUND GUIDED CENTRAL
VENOUS CANNULATION
By Dr Sunil Chhajwani (MD. Anaesthesia)
A video presentation

Indications :
Haemodynamic monitoring
Infusion of inotropes, vasodilators, vasopressors
pacing

Aspiration of air embolised into right side of heart

Infusion of fluids





Placement of ultrasound guided central venous
catheter
Ultrasound (with high resolution probe)to be kept at
the head end of patient
Probe to kept transversely caudad to needle
placement
Probe marker should face patient's left side
Trace the IJV from angle of mandible to
supraclavicular fossa using linear probe in transverse
orientatiion

Assessment of IJV

IJV diameter should be 7 mm.



Avoid access point to IJV where there is overlap
with carotid artery
Rule out thrombus in IJV
Avoid head tilt more than 30 degrees to avoid
transversing carotid artery




Use local anaesthetics without adrenaline (to prevent
inadvertent injection into carotid artery)
CVC insertion site should be prepared with usual
sterile technique
Ultrasound gel should be applied to linear probe and
sterile cover to be placed over the probe
Make sure no air bubbles between face of probe and
sterile sleeve.




IJV should be imagined and placed in centre of
ultrasound field
Needle should be angled at 40-60 degrees at the
angle of neck and 1 cm back from the middle of
ultrasound probe
If the needle is aligned correctly the soft tissue
depression should lie exactly over the IJV
Advance the needle in small increments of 0.5 cm


If the needle is seen to grow medially or laterally , it
is withdrawn till below skin tissue and then directed
towards IJV.
Correct placement of needle is indicated by indent
on IJV wall.

Make sure needle is seen inside the IJV lumen

Aspirate free flow of blood from IJV

Pass guide wire through the puncturing needle



Look for guide wire inside the lumen of IJV by USG
probe
which is seen as hyper echoic dot like shadow when
probe is kept transversely or
hyperechoic straight shadow when probe is kept
longitudinally to IJV

Dilate the tract with help of dilator

Pass central venous catheter over guide wire

Confirm the position of cvc by USG and free
aspiration of blood from all the lumens.