1. Pt supine. 15o head down
to distend neck veins & prevent air embolism (watch c-spine - if
excluded turn head away from site).
2. Cleanse, drapes, sterile gloves.
3. Local anaesthetic if awake.
4. Large caliber needle attached to a 10ml syringe with 1ml saline 1cm:
insert 1cm below the junction of the middle and medial thirds of the
5. After skin puncture, keep bevel upward, expel skin plug that may be
occluding the needle.
6. Hold needle and syringe parallel to the frontal plane. Direct
medially, slightly cephalid and posteriorly behind the clavicle toward
the posterior superior angle to the sternal end of the clavicle (toward
a finger placed in the suprasternal notch).
7. Slowly advance while withdrawing the plunger of the syringe.
8. When free flow of blood occurs, rotate bevel of needle caudially,
remove syringe and occlude with finger to
prevent an air embolism.
9. Insert guidewire while monitoring the ECG. Remove needle over
10. Insert catheter over the guidewire to a predetermined depth (tip
should be above right atrium for fluid administration).
11. Connect IV tubing and affix to skin with suture, taping tubing in
12. Get a chest film.
Arterial / neurologic injury