This video focuses on the skin nick and handling the wire and dilator in central line placement.
We will begin this section with our skin nick. Begin with your blade's sharp side pointing up on top of the wire, advancing directly over the wire, being careful not to cut the wire. After the skin nick, you can confirm that there is no skin tag by moving the wire in a small circular motion. Next, we will load our dilator onto the wire. Many people choose to use the wire loop method to increase the wire's stabilization and ease of loading the dilator. When you have your dilator loaded, advance to the skin. You dilate through only the subcutaneous tissue using a twisting motion. This will help whenever you are advancing your catheter. You can use a racking motion with the wire to ensure that you are not kinking the wire with your dilator. When you remove the dilator, make sure that you are keeping the wire in your sterile field and securing the wire at the skin. Now we can do the same motion as before, but this time loading our catheter. Advance the catheter with a similar small twisting motion and racking the wire to prevent kinking of the wire. Advanced catheter to the desired depth.
The markings on the catheter tell you how deep it is in the patient. 1 hashmark is for 10 cm, 2 hash marks for 20 cm, and 3 hash marks for 30 cm.
When removing the wire, you can attempt to reload it into the holder to make it easier should you need it again.
If you are ever concerned that your wire may have become kinked, it may be worth starting the procedure over with a new wire.
At this point, you can secure the catheter with a suture and place an antimicrobial patch.