How to Place a Central Line: Preparing Your Kit & Performing the Procedure
Correspondence should be addressed to Christopher E San Miguel, MD, MEd at Christopher.SanMiguel@osumc.edu
DOI: https://doi.org/10.5070/M5.54074
ABSTRACT:
Audience: Senior Medical Students and Interns
Introduction: Central venous catheter (CVC) placement is a critical, high-risk procedure, and it is considered a core component of emergency medicine training.1 Iatrogenic complications from improper technique—including arterial dilation, pneumothorax, and line-associated bloodstream infections—can significantly impact patient outcomes.2-7Therefore, emergency medicine trainees should ideally demonstrate procedural competence and adherence to safety practices before performing CVC insertion in clinical settings. These videos serve as part of a mastery-based curriculum designed to reinforce standardized, evidence-based techniques and institutional safety protocols for internal jugular CVC placement.8 The procedural preparation video focuses on sterile technique, ultrasound setup, and CVC kit preparation, and the procedural performance video focuses on sterile technique, the leapfrog technique for ultrasound-guided needle cannulation, and the safe insertion of the central venous catheter.
Educational Objectives: By the end of these videos, learners will be able to:
- Identify and gather all necessary materials for internal jugular (IJ) CVC placement.
- Describe the appropriate positioning of the patient, ultrasound machine, and proceduralist for CVC placement.
- List common complications of IJ CVC placement.
- Demonstrate sterile field preparation, including donning personal protective equipment (PPE), placing a sterile drape, and placement of a sterile ultrasound probe cover.
- Perform a proper pre-procedural time-out including at least two patient identifiers and site verification.
- Prepare and organize CVC kit components for efficient procedural flow.
- Identify key anatomical landmarks and optimal patient positioning for right IJ CVC placement using ultrasound guidance.
- Demonstrate stepwise needle insertion with real-time ultrasound visualization to safely cannulate the internal jugular vein.
- Verify proper guidewire placement using both short- and long-axis ultrasound views before vessel dilation.
- Perform safe dilation and catheter advancement using standard procedural technique.
- Exhibit best-practice behaviors, including port flushing, line securement, and sterile dressing application.
- Document the procedure and identify post-placement safety steps such as confirmatory chest imaging.
Educational Methods: These videos were watched by emergency medicine-bound, fourth-year medical students as asynchronous study material prior to their mastery-based central venous catheter assessment. Students watched these videos, underwent individual pre-test (baseline) assessments using a 58-item checklist, witnessed a faculty member perform a group demonstration, and then performed deliberate observed practice. The previously published, procedure checklist was developed by a multidisciplinary team of experts, and minimum passing standards were determined using the Mastery-Angoff Technique.
Research Methods: Efficacy of the videos may be inferred through baseline assessment scores, since students were given access to the videos prior to completing their baseline assessment. Utilizing a quasi-experimental design, these scores were compared to previously published data from the previous 2 years in which students completed the baseline assessment without access to the videos.9
Results: Ten fourth-year emergency medicine-bound medical students participated in a simulation-based mastery learning procedural course in March 2025. As part of their asynchronous preparation, they watched these two instructional videos: 1. Preparation to Place a Central Venous Cather and 2. Placement of a Central Venous Catheter. Learners were individually assessed in a simulation lab using a 58-item checklist. Pre-test scores ranged from 17 to 89% correct, with a median score of 67%. Previous cohorts from 2022 and 2023 had scores ranging from 19 to 84% with a median score of 43%. After deliberate practice, first post-test scores improved for participants and ranged from 89 to 98% correct.
Discussion: These educational videos were an effective component of a broader simulation-based mastery learning curriculum for central venous catheter placement. These videos provided a standardized introduction to both general and institution-specific patient safety practices related to CVC kit setup and CVC insertion. Although video views were not tracked, learners demonstrated significant improvement between pre- and post-testing, indicating the combined instructional approach was effective. Compared to previous years’ cohorts, the students who had access to the instructional videos scored better on the baseline assessment, though the small number of participants kept this difference from reaching statistical significance. The videos also allowed students to engage with the material at their own pace, reinforcing safety principles and procedural preparation in a consistent and accessible way.
Topics: Procedural Education, Central Venous Catheter, Emergency Medicine.
