• Medications

  • Anesthesia

    • Local anesthetic: 1% lidocaine

    • Conscious sedation: Fentanyl, midazolam

    • General anesthesia (if needed)

  • Heparin

  • Heparinized saline

  • Prophylactic antibiotics

    • Based to local protocol

  • Management of co-morbidities  (allergy, blood glucose, blood pressure, nausea, etc)

​

• Trolley/Equipment​​

  • Micropuncture access kit

  • Non-Tunnel line kit:

    • Catheter

      • single or multi- lumen

      • Power injection capability

    • Dilators

    • Wire (0.035”)

    • Securing mechanism/sutures/dressing

​

• Checklist

  • CIRSE (IR Patient Safety Checklist)

  • LocSSIPs (Local Safety Standards for Invasive Procedures)

  • NatSSIPs (National Safety Standards for Invasive Procedures)

  • WHO (World Health Organization Surgical Safety Checklist)

​

• Access

  • Supine position

    • Internal jugular, Subclavian or Femoral vein

​

• Technique

  • Locate the target vein with the US

  • Cleanse the access site

  • Cover with sterile drape

  • Administer local anesthetic at the skin

  • Perform a skin nick 

  • Use the micropuncture kit to access the vein under ultrasound guidance

  • Use the microwire to measure the length up to the SVC/RA junction

  • Exchange the microwire with the 0.035” wire

  • Dilate the track

  • Introduce the line over the wire

  • Confirm fluoroscopically the tip of the line at the SVC/RA junction

    • Adjust the length accordingly based to the measurement from the microwire

  • Flush/aspirate the lumens

  • Lock the lumens with heparin

    • Check manufacturer’s specifications

  • Secure the line with fixation device, stitches and dressings

​

 

• Tips​ 

  • Line can be used immediately

 

• Report

  • Describe the technique

  • Document line’s position and function

  • Mention venous patency

  • Post-procedure instructions if needed