CENTRAL VENOUS

CANNULATION
Central Venous Cannulation -
DEFINITION

Central venous cannulation = CVC is a process by which a catheter (a

cannula) is inserted into a central vein.  
Central Veins : Internal Jugular vein
Subclavian vein
Femoral vein
Central Venous Cannulation -
PURPOSE
Used for the long term administration of
1. Fluids,
2. Medication especially vasopressors, ionotropes,
hypertonic fluids
3. Chemotherapy and
4. Nutrition
5. Sampling of blood
Central Venous Cannulation -
PROCEDURE
The process of cannulation can be divided into four
steps;
1. Explanation and consent,
2. Equipment & preparation,
3. Anatomy & sono-anatomy
4. Procedure
5. Aftercare
Central Venous
Cannulation -
PROCEDURE
 Central Venous Cannulation - CONSENT
i. Confirm the patients identification
i. Check full name, DOB, and hospital number
ii. Confirm against patients wristband
ii. Explain rationale for the procedure
i. Describe the procedure
ii. State the importance of the procedure
iii. Explain the risks of the procedure to the patient
i. Infection (very serious problem with CVC - CRBSI)
ii. Injury to brachial plexus or carotid artery / subclavian artery/ femoral artery
iii. Pneumothorax, Hemothorax (subclavian>> internal jugular)
iv. Ask about relevant past medical history & review investigation
i. Rule out coagulopathy – check INR and platelet count
ii. History of prior puncture, consider sonological evaluation of intended site to rule out vascular
anomaly
 Central Venous Cannulation -
EQUIPMENT
Ensure availability of
appropriate equipment
trolley – guidewire
Cvc
1. CVC pack – 7Fr for
catheter
adults
2. Sterile Gown & Drapes
3. Gloves syringe
4. Ultrasound – linear
dilator
probe
blade
5. Monitoring equipment
needle
Central Venous Cannulation -
ANATOMY
Central Venous Cannulation -
ANATOMY
CATHETER TIP PLACEMENT

Tip placed at
cavo-atrial
junction
 Central Venous Cannulation -
PROCEDURE
i. Position the patient’s arm and hand.
ii. Scan for appropriate size vein
iii. Apply the tourniquet proximal to selected a suitable vein with just enough
pressure to occlude venous return
iv. Decontaminate your hands with aseptic agent eg Chlorhexidine 0.5%,
allowing to dry fully
v. Clean the puncture site with the chloraprep wipe and allow to air dry
vi. Placing traction on the skin below the intended puncture site, insert the
cannula with the bevel up at an angle of 30o into the puncture site
vii. Advance the cannula and observe flashback
viii. Hold the needle introducer still whilst advancing the cannula forward, over
the needle and fully into the vein
Central Venous Cannulation – AFTER
CARE
• Maintain cannulation only as long as it is necessary, all cannulae must
be removed once the patient is off intravenous therapy
• DO NOT permit any blood to remain in the cannula hub or the
extension tubing connections, as blood is a potential source of
infection
• Flush the cannula with 3-5cc NS after every injection to keep it patent
• Monitor cannula insertion site for any peri-cannula leak/ swelling/
redness/ discharge – IF PRESENT CANNULA MUST BE REMOVED