Central venous access

Dr Abdulaziz Alrabiah, MD

Definition:

• tip of the catheter is placed in the great veins or the right atrium
• it can be single lumen or multiple lumen

sites of insertion

• ✓ internal jugular vein
• ✓ subclavian vein
• ✓ femoral vein

Indications

• No peripheral IV or IO access
• CVP monitoring
  Central Venous Pressure
• drug administration ( interpose , chemotherapy , TPN …etc) interposes
  Cardiogenic shock
• renal replacement therapy
• transvenous pacing

Contraindications

• coagulopathy
• respiratory failure
• raised ICP (use femoral vein )
• obstructed vein (thrombus or tumour )
• overlying skin infection
• burn
• uncooperative patient

complications

immediate

• Pneumothorax (Subclavian > IJV)
• failure to locate vein
• arterial puncture
• haemothorax
• haematoma
• arrhythmia
• thoracic duct injury
• guide wire embolus
• air embolus

— migration of wire
needs interventional
radiology

Early

• haemopericardium → cardiac tamponade
• pneumothorax
• blockage
• cylothorax
• kinking of catheter

late infection (2.5/1000 catheters)

• catheter fracture
• vascular erosion
• vessels stenosis
• thrombosis
• osteomyelitis of clavicle

Anatomy of IJV and Subclavian vein

CC verify

• Sternocleidomastoid muscle (SCM): Located anteriorly, serving as a landmark.
• Internal jugular vein (IJV): Runs posterior to the SCM. relative to the sternocleidomastoid muscle and the clavicle. at tip between 2 head of SCM, 1/3 from the clavicle, at 45° if go deep, You may rupture the lung.
• Carotid artery: Runs anterior to the IJV, medial to the IJV.
• Clavicle: Bony structure at the base of the neck.

anatomy of femoral vein

1 cm below
inguinal ligament $45^{\circ }$ toward umbilicus
if you go more than 1 cm risk of puncturing
the Artery

method of insertion

• Confirmation of position
• ultrasound visualisation of needle insertion, guidewire placement and CVC
• chest Xray if IJV or subclavian
• pressure measurement
• assess for CVP trace