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Muhammad Usman Tariq: A Practical Overview of Central Venous Access
Muhammad Usman Tariq/LinkedIn
Apr 28, 2026, 06:29

Muhammad Usman Tariq: A Practical Overview of Central Venous Access

Muhammad Usman Tariq, Senior House Officer at Lincolnshire Community and Hospitals NHS Group, shared a post on LinkedIn:

“Central venous access (CVA) is a core skill in acute and critical care.

Safe insertion depends on clear indications, appropriate site selection, and good technique.

Indications for central venous access

  • Difficult or failed peripheral access
  • Administration of vasoactive drugs (e.g. noradrenaline)
  • Rapid fluid resuscitation
  • Parenteral nutrition
  • Central venous pressure (CVP) monitoring
  • Haemodialysis or plasmapheresis
  • Frequent blood sampling

Site selection

Internal jugular vein (IJV):

  • Preferred in many settings with ultrasound guidance
  • Lower risk of pneumothorax compared to subclavian
  • Easy compressibility – safer in coagulopathy

Subclavian vein:

  • More comfortable for patients
  • Lower infection risk
  • Higher risk of pneumothorax and difficult to compress

Femoral vein:

  • Quick and easy access, especially in emergencies
  • No risk of pneumothorax
  • Higher infection and thrombosis risk
  • Useful during cardiac arrest

Technique (overview)

  • Full aseptic precautions (cap, mask, sterile gown, gloves, drapes)
  • Patient positioning (e.g. Trendelenburg for IJV)
  • Identify landmarks with/without ultrasound
  • Local anaesthetic
  • Venepuncture – confirm venous blood
  • Guidewire insertion
  • Dilatation
  • Catheter placement and fixation

The Seldinger technique

A standard method used for line insertion:

  1. Insert needle into vein
  2. Pass guidewire through needle
  3. Remove needle
  4. Pass dilator over guidewire
  5. Insert catheter over guidewire
  6. Remove guidewire, flush and secure line

Role of ultrasound

  • Improves success rate
  • Reduces complications (arterial puncture, pneumothorax)
  • Recommended as standard for IJV access
  • Real-time guidance is preferred

Post-procedure checks

  • Confirm position (CXR for IJV/subclavian)
  • Exclude complications (e.g. pneumothorax)
  • Aspirate and flush all lumens
  • Secure line and apply sterile dressing
  • Document procedure

Major complications

Immediate:

  • Arterial puncture
  • Pneumothorax / haemothorax
  • Arrhythmias (guidewire irritation)
  • Air embolism

Early / late:

  • Infection (line sepsis)
  • Thrombosis
  • Catheter malposition
  • Vessel or nerve injury

Key points

  • Use ultrasound whenever possible
  • Choose site based on patient factors and indication
  • Maintain strict asepsis
  • Always confirm position and monitor for complications.”

Muhammad Usman Tariq: A Practical Overview of Central Venous Access

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Central Venous Access CVA Health Hematology Hemostasis News Hemostasis Today IJV Medicine Muhammad Usman Tariq Seldinger technique
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