This is the next installation in the central line (and really any Seldinger procedure) microskills. You should have already watched the videos with the following microskills:

* Syringe Suction while Manipulating

* Needle Stabilization during Syringe Removal & Wire Insertion

* Wire Manipulation

* Dilation (this video)

* Bonus Skills (Wire Straightening without Cheater)

This microskill video discusses dilation. I see this being done improperly with incredible frequency, but people get away with their bad technique because they are using small dilators for small catheters. When you go big, you will do damage unless you know what you are doing.

Dilation Mantras

* Push & Rack

* Twist & Rip

* Pinch & Pull

Additional Tips

* Keep wire and dilator wet with saline (thanks for the reminder, Matt)

* Clots are your nemesis--if there are clots on the wire, clear them off before continuing to upsize your dilators