This video focuses on techniques for threading and advancing the wire through the needle during central line placement.
We will begin with the needle already in the vessel, and you are stabilizing it with your non-dominant hand. The first technique is the thumb thread technique. In most central line kits, you will have a wire in a circular holder that you can thread with your thumb. You will insert the guidewire cap into the hub of the needle. At this point, you will use your thumb to advance the wire a few centimeters at a time. Should you meet any resistance, you should stop and reconfirm needle and wire placement with ultrasound with sterile probe cover. Once you have advanced roughly 25 centimeters, you can pull the guidewire holder off, making sure to keep the wire in your sterile field at all times. It is important to keep control of the wire-- always having at least one hand securing the wire.
Pinch and Push Technique:
In this technique, you will pull your wire about five to 10 centimeters out of the holder, leaving the guidewire tip in the introducer. At this point, you will place the guidewire tip and introducer into the needle hub. Now, pinch the wire and the guidewire holder and push the wire and holder together as a unit. Once advanced all the way, you can release the wire and pull your guidewire holder back a few centimeters, pinch again, and push forward. You can continue this movement, advancing to the 25-centimeter mark. This technique is a little easier to feel resistance and can often provide more tactile feedback.
All guidewires have a J tip at the end. Whenever you pinch near the end of the wire and pull back, it straightens out your J-tip.
At this point, you can place the straightened wire into the needle hub. Now that your wire is in the needle hub, you can slowly advance with your hand with a push technique. Again, advancing to 25 centimeters. During each of these techniques, it is important to keep a hand on the guidewire at all times. Should you encounter any difficulty threading the wire in any of the techniques, you can always reconfirm with ultrasound with sterile probe cover that you were in the vessel.