Central Venous Access- In this lecture you will learn to assess for difficult central venous access, venous thrombosis, and small caliber vessels as part of the initial scanning of the vessel to be canalized. You will also learn the technical aspects of the procedures using the EASE approach. 

How to perform Ultrasound Central Venous Access in 12 mins- This how to video, will help you learn the technical aspects of placing a cenral venous access using the EASE approach.  Duration approx. 12 mins.

CVC Pitfalls and tricks of the trade

  • The most common pitfall for central venous access is probe orientation. When performing a short axis view always keep the transducer marker toward the left of the person performing the procedure, and when in doubt, place the tip of the finger on the skin until you can orient yourself in the display. 
  • Try to estimate distance to the target vessel to avoid advancing the needle, to deep and create complications like carotid punctures or pneumothorax.
  • Start in a 45o angle to keep the needle in the field of view.
  • Always keep your eye on the needle and never advance the needle while looking at the screen because you might miss flashback.
  • When performing an Internal Jugular (IJ) vein, if the vessel is collapsing with inspiration, place the patient on reverse trendelemburg to increase venous return. If still is difficult to asses, it might be better to assess another site (like femoral vein).
  • Always confirm wire placement before dilating the vessels, to avoid mechanical complications of the procedure.