Central Line Placement (Triple Lumen CVC)

Last updated: February 9, 2026

Prepare the central venous catheter (CVC) kit beforehand. Attach caps and flush the proximal and middle ports. The distal port (brown) is where the wire will exit.

Procedure

1. Preparation: Prepare the skin with antiseptic and place sterile drapes.
2. Vascular Access: Use ultrasound to identify the internal jugular vein. Enter the vein with the needle. Using a catheter-over-needle approach is often preferred to minimize risk when sliding the catheter off the needle.
3. Confirmation: Confirm venous placement via manometry.
4. Wire Insertion: Advance the guidewire through the catheter and then remove the catheter.
5. Dilation: Use a scalpel to make a small skin incision along the wire. Advance the dilator twice to expand the subcutaneous tract before removal.
6. CVC Insertion: Advance the CVC over the wire into the vein.
7. Finalization: Remove the guidewire, secure the CVC with sutures, and order a chest X-ray (CXR) to confirm correct placement.

Clinical Considerations

The guidewire should remain stationary while advancing instruments over it to ensure a consistent path through the subcutaneous tissue and into the vein, adhering to the principles of the Seldinger technique.