Whenever my residents/fellows or I place central venous catheters (CVCs) in the operating room in a case where we’ll be performing intraoperative transesophageal echocardiography (TEE), I always place the TEE probe beforehand. I obtain a midesophageal bicaval view looking for preexisting hardware in the patient’s right atrium (RA) such as ICD wires, PICC lines, etc.
The overwhelming majority of the central lines I place are in the right jugular vein or left subclavian vein. Subclavian CVCs are typically placed with a landmark technique and confirmed with manometry. Linear ultrasound probes facilitate the placement of internal jugular CVCs. In either case, I try to see the Seldinger guidewire in the right atrium prior to dilation and catheter placement.