Percutaneous non‐tunnelled CVCs are commonly used for patients in acute settings and insertion may be in response to an emergency or planned event (Hamilton [198], Wilkes [472]). Their multilumen configuration allows administration of several solutions at once and they are easy to remove (Dougherty [123], Ives [225]). However, these catheters are associated with an increased risk (e.g. compared to PICCs) of complications such as pneumothorax and infection (Chantler [69]). Additionally, the catheter material results in irritation of the inner lumen of the vessel and is more thrombogenic than softer silicone catheters (Dougherty [123], Springhouse [426]).

These catheters are usually placed in the jugular, subclavian or femoral veins. The shortest catheter and the most direct route are required to create rapid blood flow around the catheter, which reduces irritation and obstructions and the risk of complications, and increases the dwell time of the catheter (Loveday et al. [278], O'Grady et al. [362], Weinstein and Hagle [465]). The preferred veins for most short‐term CVCs are the subclavian and internal jugular (Smith and Nolan [418], Weinstein and Hagle [465]). The subclavian route has a lower risk of infection (Chantler [69], Parienti et al. [368]), allows greatest patient mobility after insertion and provides a flatter surface on which to maintain a dressing (Hadaway [194]). Its disadvantages are an increased risk of pneumothorax and difficulty controlling bleeding (Bodenham et al. [43], Chantler [69]).

The jugular vein approach can be via the internal or external jugular vein. The anatomical location of the internal jugular vein makes it easier to catheterize than the subclavian vein and there is less risk of pneumothorax (Bodenham et al. [43], Chantler [69], Hadaway [194], Smith and Nolan [418]). The external jugular vein is observable and easily entered, with rare insertion complications (Weinstein and Hagle [465]), but central catheter positioning can be difficult when using this route (Bodenham et al. [43]). Disadvantages include catheter occlusion and venous irritation as a result of head movement, difficulty in maintaining an intact dressing, and the position of the catheter being disturbing for the patient and their family (Chantler [69], Dougherty [123], Weinstein and Hagle [465]).

The femoral veins are primarily only used for short‐term access when other sites are not suitable (O'Grady et al. [362]) but they are preferred to the subclavian route for short‐term dialysis catheters (Smith and Nolan [418]). This route is associated with an increased risk of infection and thrombosis, difficulty in maintaining an intact dressing and inhibiting the patient's mobility (Chantler [69], Dougherty [123], Hadaway [194]) Although the groin may have a higher microbial colonization rate, tunnelling devices away from the groin may reduce such risks (Bodenham et al. [43]).

Central venous catheter insertion is a sterile procedure and the insertion should be performed following a central venous catheter care bundle, which should include the use of a theatre cap, mask, sterile gloves, a gown and sterile full‐body drapes (DH [118], Gorski et al. [181], Loveday et al. [278], O'Grady et al. [362], RCN [381]). These catheters should be inserted in a controlled environment to reduce the risk of contamination (Dougherty [123]). This procedure is performed by doctors, nurses and allied health professionals who have been taught all aspects of catheter insertion principles and practice (Alexandrou et al. [8], Smith and Nolan [418]).

Ultrasound guidance should be used routinely when a CVC is being inserted via the jugular or femoral vein, whether in an elective or emergency situation (NICE [349], Smith and Nolan [418], Wigmore et al. [470]). Ultrasound‐guided catheterization of the subclavian vein is possible with the use of a slightly more lateral approach (Smith and Nolan [418]). In fact, entry is more into the axillary vein (Schmidt et al. [404]). Ultrasound provides the operator with visualization of the target veins as well as other surrounding anatomical structures, including any variations that the patient may have in their anatomy. It increases first‐time puncture success rates while decreasing complication rates (Kelly [241], NICE [349]).

Placing the patient in the Trendelenburg position facilitates entry to the vein by distending the vein, increasing central venous pressure and venous blood supply, and making veins more visible and accessible (Farrow et al. [144]). It also reduces the chance of air embolism because the venous pressure is higher than the atmospheric pressure. This is especially important when the catheter is placed using the subclavian approach (Dougherty [123]). A rolled towel may be placed under the patient's back along the spinal cord and between the shoulders to hyperextend the neck and clavicle (Weinstein and Hagle [465]).

The Valsalva manoeuvre can be performed by conscious patients to aid insertion of the catheter and to prevent air embolism (Cowlishaw and Ballard [92], Dougherty [123], Verghese et al. [452], Weinstein and Hagle [465]). The patient is asked to breathe in and then try to force the air out with the mouth and nose closed (i.e. against a closed glottis). This increases the intrathoracic pressure so that the return of blood to the heart is reduced momentarily and the veins in the neck region become engorged (Dougherty [123]).