Difference between revisions of "Central line: supraclavicular"

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==Indications==
+
{{Central line 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==
+
{{Central line 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}}
+
{{Central line equipment}}
 
 
==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==

Revision as of 20:37, 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

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]

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

  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. Graham, A.S., et al. Central Venous Catheterization. N Engl J Med 2007;356:e21
  2. Fisher NC, Mutimer DJ. Central venous cannulation in patients with liver disease and coagulopathy—a prospective audit. Intens Care Med 1999; 25:5
  3. Morado M.et al. Complications of central venous catheters in patients with haemophilia and inhibitors. Haemophilia 2001; 7:551–556