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Chapter 32 ■ Central Venous Catheterization 199

care. Do not clamp or suture; stretch or apply tension

to catheter.

j. Utilizing sterile technique and a 3- to 5-mL syringe,

flush catheter with heparinized saline solution, leaving syringe attached. A small-barreled syringe (such

as a 1-mL syringe) may generate too much pressure,

resulting in catheter rupture (12).

k. Prepare sterile field: Holding the extremity with sterile gauze prepare a large area at and around the

insertion site, working outward in concentric circles.

Allow the prep solution to dry. Repeat process with

new gauze/prep solution. Place a large sterile drape

under and above the extremity, leaving only the

insertion site exposed. A large drape or multiple sterile towels should be used to cover an area well

beyond the extremity to decrease the risk of accidental contamination (2).

3. Catheter insertion using a break-away needle

(Fig. 32.2) or a peel-away introducer (Figs. 32.3, 32.5)

a. Apply tourniquet above insertion site on extremity

(optional).

b. Providing slight skin traction, insert needle about

0.5 to 1 cm below the intended vein, at a low angle

(approximately 15 to 30 degrees).

c. When a flashback is obtained, advance the needle

about 5 to 6 mm at a lower angle to ensure that the

whole bevel of the needle is within the vein. If a

peel-away introducer with a needle is used, remove

the needle at this time and advance the introducer

sheath slightly. If the introducer (needle or sheath)

is well within the vein, there will be continued

blood flow through it.

d. Remove the tourniquet.

e. Using nontoothed iris forceps, gently grasp the catheter about 1 cm from its distal end and thread it

slowly into the introducer, a few millimeters at a

time.