Central and arterial line insertion viva

Preparation. Full sterile barrier, chlorhexidine prep, Trendelenburg, continuous monitoring, US scout of IJ and carotid. Consent or emergency justification. Local anaesthetic within weight-based limits.^[1]

Technique. Transverse then in-plane/out-of-plane needle entry under US into compressible vein; aspirate dark non-pulsatile blood; pass J-wire without resistance; control wire at all times; dilate; pass catheter ~12–15 cm right IJ; aspirate/flush all lumens.^[1][2]

Confirmation. US wire/catheter in vein; CXR for tip at cavoatrial junction and no PTX before relying on the line for potent drugs when possible (do not delay life-saving vasopressors if clinical confirmation is solid and patient is crashing — but still obtain CXR ASAP).^[1]

Arterial line. Modified Allen test; US-guided radial cannula; transducer zeroed at heart level.^[3]

Complications. Arterial puncture — withdraw, pressure; never dilate artery. PTX — oxygen, drain if symptomatic. Wire embolism — never let go of wire. CLABSI — bundle compliance.^[1]