Central line: supraclavicular

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

• Infection over the placement site
• Distortion of landmarks by trauma or congenital anomalies (including c-collar)
• Pathologic conditions, including SVC syndrome
• Current venous thrombosis in target vessel
• Prior vessel injury or procedures
• Morbid obesity
• Uncooperative patient

Central line if coagulopathic

• Preferentially use a compressible site such as the femoral location (avoid the IJ and subclavian if possible, though IJ preferred over subclavian)
• No benefit to giving FFP unless artery is punctured
  • However, consider giving FFP if patient has hemophilia

Equipment Needed

• CVC kit: typical contents:
  • Clorhexidine
  • Sterile drape
  • 1% lidocaine without epinephrine
  • 5 mL syringe (for lidocaine)
  • 22-ga and 25-ga needles (for lidocaine)
  • 5 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, sterile gloves
• For ultrasound guided placement (preferred method)
  • Ultrasound machine and probe (vascular probe)
  • Sterile probe cover with sterile gel
• Biopatch
• Sterile caps for lumen ports
• Tegaderm
• Sterile saline

Procedure

1. 1cm lat to scm head
2. 1cm post to clavicular head
3. bisect angle btwn scm & clavicle
4. 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

• Central line