![]() The femoral vein lies in the femoral triangle of each thigh and maintains a medial relationship to the common femoral artery. The right and left brachiocephalic veins then join together to form a common superior vena cava. The subclavian vein lies next to the subclavian artery, and courses out of the axilla across the lateral upper chest where it quickly dives deep to the clavicle before forming a confluence with the internal jugular vein which then becomes the brachiocephalic vein. In the lateral neck, the IJ is located next to the carotid artery, with the vein lying lateral to the artery in most patients, deep to the sternocleidomastoid muscle. These large diameter central veins are located universally near a large artery. Ĭentral venous catheters are placed typically in one of 3 large central veins: the internal jugular vein (IJ), subclavian vein (SCL), or femoral vein. This activity focuses on the complications of line placement. This procedure is generally performed with ultrasound guidance unless an ultrasound machine is unavailable or there are other exigent circumstances, in which case a palpation guided approach can be used. Despite the general overall safety of this procedure, complications do occur. Most central lines are placed today via the Seldinger technique (a safety enhancement over the previous "cut-down" technique), in which the chosen vein is cannulated with a needle, a guidewire is inserted to maintain a tract through the skin into the vein, and the catheter is then inserted over the wire into the vein before the wire is removed. Central lines may also be placed to introduce Swan Ganz catheters to measure internal hemodynamics of the heart, or to introduce temporary transvenous pacemaker leads in the critically ill patient who has severe bradycardia or high-degree heart block: these are called introducer catheters. Some central lines are also placed for temporary or permanent hemodialysis access these dialysis catheters are significantly larger than traditional double, triple, or quadruple lumen catheters placed in the emergency department (ED) or intensive care unit (ICU) setting. Indications include patients with multiple, incompatible intravenous (IV) medications with limited peripheral access, or who are being treated with vasoactive or phlebosclerotic agents which may not be suitably cared for with a peripheral IV alone. ![]() This activity reviews the indications, contraindications, and technique involved in performing central line placement and highlights the role of the interprofessional team in the care of patients undergoing this procedure.Ĭentral venous catheterization (CVC) is a procedure frequently required in acute or critical care resuscitation. Most central lines are placed today via the Seldinger technique, which is safer than the previously used "cut-down" technique. Central lines may also be placed to introduce Swan Ganz catheters to measure internal hemodynamics of the heart, or to introduce temporary transvenous pacemaker leads in the critically ill patient who has severe bradycardia or high-degree heart block these are called introducer catheters. Some central lines are also placed for temporary or permanent hemodialysis access these dialysis catheters are significantly larger than traditional double, triple, or quadruple lumen catheters placed in the emergency department or intensive care unit setting. ![]() Indications include patients with multiple, incompatible intravenous (IV) medications with limited peripheral access, or who are being treated with vasoactive or phlebosclerotic agents which may not be suitably cared for with a peripheral IV alone. Central venous catheterization (CVC) is a procedure frequently required in acute or critical care resuscitation.
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