This video focuses on handling the syringe and needle during central line placement.
Connect your 10 mL syringe and introducer needle. Now, release the suction from the plunger on the syringe, as this can cause difficulty if you do not do this before advancing your needle. Most people like to place the pointer (index) and ring fingers of their dominant hand on the syringe's wings and thumb and middle finger on the plunger. This allows you to push forward on the syringe while pulling back on the plunger with your fingers. This is important as you are advancing the needle to be able to aspirate as you are entering the vessel. There are other techniques to handle the syringe; you should use whatever method is comfortable for you.
Now that you are handling the syringe comfortably, relocate the vessel with your ultrasound with a sterile probe cover using your non-dominant hand. Using the syringe, with the needle bevel up, advance your introducer needle under ultrasound guidance until you are in the vessel visualizing on ultrasound and aspirating blood. Once you are aspirating blood, you can place your ultrasound down and secure your needle using your non-dominant hand and resting your hypothenar eminence on the patient. This allows you to have complete control over the needle still in the patient. It is important not to hold the needle with your hand in the air, as air stabilization is not optimal, and the needle can easily be removed from the vessel. At this point you can place a 2x2 or 4x4 gauze under the needle to prevent any leaking of blood from the vessel and can keep the site clean and dry. Now that you are securing your needle with your non-dominant hand, you can remove the syringe from the needle. As you see non-pulsatile blood returning from the needle, if blood is leaking out, you can cover the needle hub with your pointer (index) finger to prevent excess bleeding.
There are many great tips for central line placement, and we’ve got a few more in this series.