Emcrit central line post
Emcrit central line microskills
Emcrit central lines part 1
Emcrit central lines part 2
CVL microskills
- Syringe manipulation: negative pressure on plunger while advancing syringe and needle. Plunger head between IF and MF, thumb on flange of syringe. Like a pencil grip. Practice pulling plunger back all the way by running IF along length of your thumb.
- Needle stabilization: left hand like it’s holding a pool cue, with a wide base stabilized on the patient’s body
- Syringe disconnect: twisting motion without moving the needle
- Wire manipulation: slide wire into needle and vein using alternating grasp and release, wire passes tip of needle at first mark (10cm), straighten guidewire with one hand if needed by separating thumb/IF grip and palm/SF grip
- Skin incision: with blunt side of blade on wire, wiggle the wire to assure that you have no skin bridge
- Dilator loading: rest the end of the guidewire on a fingertip (RF) to stabilize along one plane
- Dilation: left hand holds wire and provides counter-tension on skin, dilator is advanced through skin in twisting motion, grasp body of dilator (not the hub)
- Line placement over wire: stabilize wire on fingertip, skin counter-tension
- Wire removal: slide wire out of vein and needle by alternating grasp and release backwards, may slide wire back onto sheath for easier disposal
- Catheter flush: lure lock caps on catheter hubs, syringe held vertical, aspirate air bubbles first, then flush line
- Line securing: biopatch, suture, tegaderm, suture extra rubber clamp if used as well as junction hub, cover both with tegaderm