As it travels towards the chest, it assumes an anterolateral position to the common carotid artery beneath the sternocleidomastoid muscle. It is contained within the carotid sheath and travels with the carotid artery and the vagus nerve. The internal jugular vein exits the skull base from the jugular foramen collecting blood from the sigmoid sinus. However, when ultrasound guidance is not feasible, CVLs may be placed using anatomical landmarks without ultrasound. Ultrasound guidance can benefit all approaches and is recommended for every CVL placement. The subclavian vein approach is at higher risk for pneumothorax than the internal jugular vein approach. The femoral veins are compressible sites and, as such, may be more appropriate for patients who are at high risk of bleeding. The right internal jugular and subclavian valves are the most direct paths to the right atrium via the superior vena cava. There are three possible sites for CVL placement in adult patients: namely, the internal jugular, femoral, and subclavian. This article will detail the anatomy of the site placement, indications and contraindications, equipment and personnel involved, technique, preparation, and associated complications.
With ultrasound guidance, standardized techniques, new catheter designs, and central line care bundle, this procedure has become ubiquitous in the intensive care unit. Over the past decade, there has been tremendous improvement and reduced complications associated with central line placement procedures. According to epidemiologic data, 8% of hospitalized patients require central venous access, and more than 5 million central venous catheters are inserted in the United States annually. Central line placement is an essential skill, especially in critical care units.
Now referred to as the Seldinger technique, this procedure allows the safe and reliable insertion of a central venous catheter in the large lumen central veins. Sven-Ivar Seldinger, in 1953 introduced the method to facilitate catheter placement into the central veins lumens. Explain a structured, interprofessional team approach to provide effective care and appropriate surveillance of patients undergoing central line placement.Ī central venous line (CVL) is a large-bore central venous catheter placed using a sterile technique (unless an urgent clinical scenario prevents sterile technique placement) in specific clinical procedures.Summarize the equipment required for central line placement.Outline the complications associated with central line placement.Describe the anatomy that is relevant to central line placement.This activity reviews the indications, techniques, possible complications, and ways to reduce the risk of complications associated with central line placement to increase healthcare provider knowledge and ability of the procedure and improve clinical outcomes. Understanding this procedure's proper technique and potential complications can help minimize central line-associated complications and improve clinical outcomes. Complications of central line placement include pneumothorax, hematoma, bleeding, infection, and extravasation. Like any procedure, it has its complications, some of which can be life-threatening. Central line placement is essential in caring for many critically ill and hospitalized patients. Many healthcare practitioners insert central lines.
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