Brought to you by Haru Okuda, MD FACEP
NYCHHC Institute for Medical Simulation and Advanced Learning (IMSAL)
and
Scott Weingart, MD FACEP
Sterility
In the ED, there are only two ways to place central lines:
Full Sterile
or
Non-Sterile
There is no in-between. Sometimes (hopefully rarely), the exigencies of time or patient condition will prevent placing a full sterile line. This is acceptable so long as you inform the accepting service that the line is not full sterile. If however you state the line is full sterile, you are in effect
Swearing on Your Patient’s Life
that EVERY single step of the sterile placement process was followed without breaks. If you can’t swear on your patient’s life that this is true, then just say to the accepting service that the line was non-sterile and they will replace it.
Here is a video of how to place a full sterile line
Click Here to Download the Video
Look for this area in the lower right of the screen
How to Place a Line
How to perform a blind IJ line placement with all of the steps
Click Here to Download the Video
Look for this area in the lower right of the screen
How to perform an infraclavicular subclavian line, with just the steps
that are different from the IJ
Click Here to Download the Video
Look for this area in the lower right of the screen
How to Place a Sheath Introducer (Cordis)
Click Here to Download the Video
Look for this area in the lower right of the screen
Tough Situations
Are you in the Artery or the Vein?
Click Here to Download the Video
Look for this area in the lower right of the screen
—
Special thanks to John Ponessa for editing wizardry and Tim Clapper for the educational development.
Hi, my name is Scott Weingart. 
Beautifully presented, Scott. Wish I had seen these 10 years ago! Will share with our ICU attendings for use with the residents.
Do you have any videos on use of US for IJ placement? I couldn’t find any at this site.
My friend John Rose has a nice tutorial at UC Davis…if you don’t plan to present one, you may want to suggest his or another.
Many thanks for these great presentations. You are touching countless patients’ lives by helping us improve our practice.
Joe
Hi Scott. Wondering why you switch the needle to the catheter. Why can’t you just attach the extension tubing or wire-sheath directly to the introduce needle?
Mike,
you can, but there are a few risks. If you move the needle when attaching the tubing, you will get a falsely low reading and may actually lose the line
if you pass in the catheter, then make sure there is still flow
you can be sure you will get an accurate transduction and then not risk losing the line when taking the tranduction tubing back off