Difference between revisions of "Central line: supraclavicular"

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{{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
{{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:
**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
**Scalpel with 11-blade
**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
*Sterile caps for lumen ports
*Sterile saline

Revision as of 20:37, 11 January 2015


  • Central venous pressure monitoring
  • Administration of multiple medications and drips
  • High volume/flow resuscitation[citation needed]
  • Emergency venous access
  • Inability to obtain peripheral venous access
  • Repetitive blood sampling
  • Administering hyperalimentation, vasopressors, caustic agents, or other concentrated fluids
  • Insertion of transvenous cardiac pacemakers
  • Hemodialysis or plasmapheresis
  • Insertion of pulmonary artery catheters



  • 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


  • 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


  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


  • Arterial puncture and hematoma
  • Pneumothorax
  • Hemothorax
  • Vessel injury
  • Air embolism
  • Cardiac dysrhythmia
  • Nerve injury
  • Infection
  • Thrombosis
  • Catheter misplacement

See Also


  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