The long needle that comes attached to some types of central venous catheters comes with a needle and guard that can be cumbersome,
especially in small patients. So when peripherally placing a central venous catheter, I do not use this needle; instead, I
do the following: Using a sterile technique, I remove the needle along with the guard (Figure 1). I place a regular 16- or 18-ga IV catheter into the lateral or medial saphenous vein, checking before placement that the
central line will fit through the lumen of the IV catheter. Then I remove the stylet and place the central line through the
IV catheter (Figure 2). This long central venous catheter can be passed its entire length and fed into a central vein. The central venous catheter
can then easily be attached to a T-port to facilitate fluid therapy, parenteral nutrition administration, or the collection
of repeated blood samples (Figure 3).
Dr. Alexis Newman
Downers Grove, Ill.