Best Practices for Central Line Insertion

Recent advances in central line insertion techniques, increased attention to preventing central line infections, and improved training strategies have dramatically improved the process of central line insertion. For many aspects of line insertion, best practices are beginning to emerge. These include an organized, systematic approach to inserter training and line insertion, consistent, specific aseptic preparation of the patient and inserter, use of static and dynamic ultrasound when feasible, evidence-based site selection, verification of wire position, localization of the catheter tip, and postinsertion maintenance. The results of these recent advances are clear: a dramatic, widespread, and persistent fall in the rate of central line-associated bloodstream infections. With further implementation of "bundled" line insertion strategies, advances in simulator training, and increasing ultrasound use, it is possible that other central line complications my also decrease in incidence. The ongoing attention to central line safety may lead to even further advances in central line safety. © 2013, Lippincott Williams & Wilkins.