1. HOW TO PERFORM THE ONE-
HANDED ULTRASOUND-
GUIDED IJ CENTRAL LINE
Daniel Gromis, MD

2. POSITIONING
Trendelenberg (head “down-enberg”) will improve venous
filling, distention, and therefore visualization and canalization
Do NOT exceed 10-15˚
Excessive T-berg increases risk of ICP increase, intrapulmonary
edema shift, respiratory difficulties
Have the pt’s head turned only slightly away from the side of
attempted placement
Do NOT exceed 10-15˚ from midline as this will cause venous
collapse

3. THE IMAGE AT LEFT SHOWS HOW LITTLE T-BERG IS NEEDED, THE
IMAGE AT RIGHT SHOWS OPTIMAL HEAD ROTATION
Avoid having the patient look toward their shoulder, as in the image on the right!

4. SETUP
Open the kit
Apply the isolation barriers to the patient and prep the neck
Drop the probe in the sterile sheath and drape over available
IV tree
Get sterile yourself and double-glove (this way if you
contaminate yourself, you can just take off the gloves and not
have to start over)
Flush your lines and apply Luer locks to all but the brown
port (just flush and lock with the clasp)

5. SETUP
Hanging the prepped probe with sterile cover
Prepping, flushing, and Luer locking the lines
No Luer lock on the brown port, only clasp

6. TECHNIQUE
Site your landmark with the probe and make
an indentation on the skin with the scout
needle’s protective sheath still applied
Remember the pythagorean theorem, if your
target is 2cm deep, make your mark 2cm back
from the probe and aim toward your target at a
45˚ angle
Also remember, your “target” is the center of
the vessel, not the anterior wall!

7. EXTERNAL CONFIRMATION
With the needle cover still on, bounce the needle to
confirm appropriate alignment...you should see the
vein collapse as you depress the needle, confirming
location
w/o w/ comp
comp

8. INTRODUCING
Hold the needle as illustrated below, only applying
0.2-0.5cc of negative pressure, as an excessive vacuum
can suck up the vein wall and complicate flash
When introducing the needle, use your opposite hand to
assist with penetration of the epidermis to avoid “plunging”
into the neck

9. SKIN PENETRATION
When initially introducing the needle,
use your other hand to assist with
counter-traction to facilitate epidermal
penetration. After the epidermis is
breeched, then apply the probe.
This is particularly important in ethnic
patients with tougher epidermal skin or
patients with scar tissue from prior IJs
to avoid “plunging” into the neck