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Central line: supraclavicular
From WikEM
Contents
Indications
- Central venous pressure monitoring
- High volume/flow resuscitation
- Emergency venous access
- Inability to obtain peripheral venous access
- Repetitive blood sampling
- Administering hyperalimentation, caustic agents, or other concentrated fluids
- Insertion of transvenous cardiac pacemakers
- Hemodialysis or plasmapheresis
- Insertion of pulmonary artery catheters
Contraindications
Absolute[1]
- Infection over the placement site
- Anatomic obstruction (thrombosis of target vein, other anatomic variance)
- Site-specific
- Subclavian - trauma/fracture to ipsilateral clavicle or proximal ribs
Relative
- Coagulopathy (see below)
- Distortion of landmarks by trauma or congenital anomalies
- Prior vessel injury or procedures
- Morbid obesity
- Uncooperative/combative patient
Central line if coagulopathic
- Preferentially use a compressible site such as the femoral location (avoid the IJ and subclavian if possible)
- No benefit to giving FFP unless artery is punctured[2]
- However, consider giving FFP if patient has hemophilia[3]
Equipment Needed
- CVC kit typically contains:
- Chlorhexidine
- Sterile drape
- 1% lidocaine without epinephrine
- 5 mL syringe (for lidocaine)
- 22-ga and 25-ga needles (for lidocaine)
- 5-10 mL syringe (for venipuncture)
- 18-ga needle (for venipuncture)
- Guidewire
- Scalpel with 11-blade
- Dilator
- Triple-lumen catheter (or introducer catheter/Cordis)
- Catheter clamp
- Silk suture
- Sterile gown, cap, mask, gloves
- Biopatch
- Tegaderm
- Sterile saline flush
- Sterile caps for lumen ports
Procedure
- 1cm lat to SCM head
- 1cm post to clavicular head
- bisect angle between SCM & clavicle
- 10' angle inf to horizontal plane
Complications
- Arterial puncture and hematoma
- Pneumothorax
- Hemothorax
- Vessel injury
- Air embolism
- Cardiac dysrhythmia
- Nerve injury
- Infection
- Thrombosis
- Catheter misplacement
See Also
References
- ↑ Graham, A.S., et al. Central Venous Catheterization. N Engl J Med 2007;356:e21
- ↑ Fisher NC, Mutimer DJ. Central venous cannulation in patients with liver disease and coagulopathy—a prospective audit. Intens Care Med 1999; 25:5
- ↑ Morado M.et al. Complications of central venous catheters in patients with haemophilia and inhibitors. Haemophilia 2001; 7:551–556
