DECIDEMassive transfusion, anticipated or running (MTP). · Need big-bore volume → use the AVA 3Xi. · If only drug and monitoring access is needed, place a plain triple-lumen instead — Central Venous Catheter.
STEPS · ◆ KEY STEP — LOGGED WITH ITS TIME
TECHNIQUE — STEP BY STEP
Site, position and Seldinger steps are identical to a standard CVC.
Nick the skin generously, then dilate deliberately.
Advance the unit over the wire to depth, withdraw the wire, confirm it is fully out.◆ INTRODUCER IN — WIRE OUT
AVA 3Xi: the triple-lumen threads through the sheath valve in the same pass.
Plain Cordis: cap the large-bore lumen if you are not using it right away.
Secure: two sutures + Biopatch + Tegaderm, same as Central Venous Catheter. Confirm: CXR — tip position, no pneumothorax.
PERIPHERAL 20G ~60 · 18G ~105 · 16G ~220 ML/MIN
TRIPLE-LUMEN CVC — 18G PORTS ~26 ML/MIN EACH · 16G/BROWN PORT ~52 ML/MIN
TEACHING POINT: A PERIPHERAL 16G OUTFLOWS A TRIPLE-LUMEN CVC'S BEST PORT
EQUIPMENT
Pick the device: plain Cordis 8–9 Fr, or AVA 3Xi 8.5 Fr. Check the kit before opening it.
Kit contents: 18 g introducer needle + syringe, J-tip guidewire, dilator (larger than a standard CVC dilator — expect more resistance), sheath/catheter unit, integral sterile catheter sleeve.
Ultrasound + high-frequency linear probe, sterile probe cover and gel.
Full barrier and prep, same as Central Venous Catheter. Dressing tray, 600 mL bowl, 150 mL gallipot.
Pressure bag or rapid infuser if this line is for massive transfusion.
IN THE KIT — 8 ITEMS · ROOM 7 (RESUS BAY) CABINET · VASCULAR ACCESS
Introducer sheath 8–9 Fr — Cordis-type, or AVA 3Xi if a second lumen is needed ×1
18 g introducer needle + syringe×1
J-tip guidewire×1
Dilator — larger than a standard CVC dilator ×1
Sterile probe cover + gel×1
Suture 3-0 non-absorbable + needle driver×1
Non-return valve caps×1
Biopatch + Tegaderm×1
ALSO NEEDED — NOT IN THE KIT
Full barrier kit (gown, gloves, cap, mask, large drape) from the shelf. Use a pressure bag or rapid infuser if this line exists for massive transfusion.
DRAFT — not yet assembled or signed off. The dilator is larger than a standard CVC dilator.
FIGURE
The AVA 3Xi combines a Cordis-style large-bore introducer lumen with an integrated triple-lumen catheter in one device, placed with one stick: drugs and monitoring through the standard ports, volume through the introducer.
PITFALLS & PEARLS
Placing a plain triple-lumen when MTP is already anticipated — slower than a 16 g peripheral.
Running products through gravity alone.
Confusing this with a plain triple-lumen on the shelf — check the label.
Same wire and dilation cautions as Central Venous Catheter, at a larger scale.