INDICATIONLarge-bore vascular access for massive transfusion / rapid volume resuscitation when a standard triple-lumen catheter's flow can't keep up — ultrasound-guided Seldinger technique, full sterile barrier precautions.
NOT the same poster as Central Venous Catheter (CVC). That poster covers the standard triple-lumen line for drugs/monitoring. This one covers the large-bore line for volume. Different device, different reason to reach for it — see the DECISION box below.
EQUIPMENT
RESUS BAY · LARGE-BORE ACCESS KIT + ULTRASOUND
Pick the device: plain Cordis-type introducer sheath (8–9 Fr, one large-bore lumen — also accepts a 2nd catheter, e.g. PA line/pacer wire) or AVA 3Xi (8.5 Fr) — large-bore lumen + integrated triple-lumen catheter, one stick
Kit: 18g introducer needle + syringe, J-tip guidewire, dilator (larger than standard CVC — expect more resistance)
Ultrasound + high-frequency linear probe, sterile probe cover and gel
Full barrier: sterile gown/gloves/cap/mask, large drape, dressing tray, 600 mL bowl + 150 mL gallipot for flush
Pressure bag or rapid infuser — gravity alone leaves most of this device's speed advantage on the table
Skin prep: chlorhexidine 2% in 70% alcohol or povidone-iodine, 2× 15 cm foam applicators
To finish: suture kit with 3/0 non-absorbable, gauze, Biopatch, Tegaderm, non-return cap(s), saline flushes
DECISION — WHEN TO CHOOSE THIS OVER A PLAIN TRIPLE-LUMEN
Anticipated/active massive transfusion (MTP) where a triple-lumen's fastest port can't keep up
Need large-bore volume AND standard drug/monitoring ports from one site — that's the AVA 3Xi specifically
Anticipated 2nd catheter (PA line, pacer wire) through the same lumen — plain Cordis
Only need standard access, volume isn't the priority? Place a plain triple-lumen CVC instead
STEPS
Site, position, prep, and Seldinger technique are identical to a standard CVC — right IJ preferred, ultrasound-guided puncture, Trendelenburg, full sterile drape.
Puncture under real-time ultrasound at ~45°, thread the J-wire — never force it, stop at ~15 cm. NEVER let go of the wire.
Confirm the wire in transverse AND longitudinal planes before dilating.
Dilate deliberately — this dilator is larger than a standard CVC's; expect more resistance, nick the skin generously first.
Advance the sheath/catheter unit over the wire to target depth; withdraw the wire, confirm it's fully out.
AVA 3Xi: the integrated triple-lumen catheter threads through the sheath's hemostasis valve in the same pass — no second stick. Aspirate/flush all standard ports.
Plain Cordis: if the large-bore lumen isn't being used for a 2nd catheter right away, cap it with its own hemostasis valve.
Secure with two sutures + Biopatch + Tegaderm; CXR to confirm tip position, no pneumothorax.
Run products through a pressure bag or rapid infuser — gravity alone won't realize this device's flow advantage.
Don't confuse this with a plain triple-lumen CVC on the shelf — check the label. The large-bore lumen is what makes it useful for MTP, and not every central-line kit on the cart has one.