You scrub the clavicular with chlorhexidine. Then, you grab the central line kit, and a syringe with saline. Then, unclamp the lumen of the central line and flush the lumens with saline. Once you've done that you clamp the lumen. Then, you repeat the process for the other two lumens. Then, you select a local anesthetic, and infiltrate the skin with 1ml of lidocaine just lateral to the posterior bend of the clavicle. Then, you select the insteration needle with attached syringe. Then, orient the needle bevel caudally and at 30 degrees angle to the skin to facilitate guidewire passage. Then, you insert the needle into the skin at the lateral border of the clavicle while pulling back on the plunger to apply negative pressure. Then, you'll stop at the inferior of the clavicle. Then, place your thumb at the over the needle connector. Then, select the guidewire, and inserts the guidewire into the needle and progress carefully into the subclavian vein. Once, the EKG shows a irregular arrhythmia you stop. Then, remove the needle, and keeps the guidewire in place and then you select the 11 blade, and makes a small incision into the skin next to the entry point of the guidewire to facilitate placement of the dilator. Then, select the dilator and place the dilator over the guidewire and advances it 1-2 cm into the skin while rotating the guidewire. Then, select the central line catheter, and places the catheter over the guidewire and begins to insert the catheter while rotating it and then you take the guidewire out of their skin and insert the catheter until the tip is at the junction of the superior vena cava and the right atrium. Then, put caps on hubs of catheter and then suture it in place and then you'll need to put a adhensive pad over it.
Use alcohol wipes!!
