Difference between revisions of "Central line: supraclavicular"

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 +
==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 with coagulopathy}}
 +
 +
==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==
 
==Procedure==
 
# 1cm lat to scm head
 
# 1cm lat to scm head
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# 10' angle inf to horizontal plane
 
# 10' angle inf to horizontal plane
  
==Contraindications==
+
==Complications==
{{Central line with coagulopathy}}
+
*Arterial puncture and hematoma
 +
*Pneumothorax
 +
*Hemothorax
 +
*Vessel injury
 +
*Air embolism
 +
*Cardiac dysrhythmia
 +
*Nerve injury
 +
*Infection
 +
*Thrombosis
 +
*Catheter misplacement
  
 
==See Also==
 
==See Also==
*[[Central lines]]
+
*[[Central line]]
  
==Source==
+
==Sources==
<references/>
+
<references/>  
  
 
[[Category:Procedures]]
 
[[Category:Procedures]]

Revision as of 20:03, 11 January 2015

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)
  • No benefit to giving FFP unless artery is punctured[1]

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

Sources

  1. Fisher NC, Mutimer DJ. Central venous cannulation in patients with liver disease and coagulopathy—a prospective audit. Intens Care Med 1999; 25:5
  2. Morado M.et al. Complications of central venous catheters in patients with haemophilia and inhibitors. Haemophilia 2001; 7:551–556