![]() ![]() ![]() Carefully drop the sterile ultrasound probe cover and saline onto the open sterile kit.In this manner the contents of the kit and the exposed surface (inside surface) of the wrapping will remain sterile. Open the flaps of the sterile wrapping by grabbing the non-sterile side of the wrap and opening outward.Clean the area liberally with chlorhexidine solution, scrubbing vigorously for 60 seconds and allowing to dry for 30 seconds.The right subclavian vein is generally preferred for the central venous access because of the presence of the thoracic duct and the higher pleural dome on the left side. Many practitioners find it helpful to place a rolled-up towel under the medial portion of the patient's scapula to help accentuate the physical landmarks, although too much shoulder retraction may decrease the space between the clavicle and first rib, compressing the subclavian vein. This allows for maximal engorgement of the target vessel and helps to prevent the introduction of an air embolus. Place the patient supine with the feet elevated (Trendelenburg position) prior to the start of the procedure. ![]() The contents of the kit are enclosed in a sterile tray wrapped with a sterile cover. Commonly marketed CVC kits generally contain the central venous catheter (in this case a triple lumen catheter), a j-tip guide wire, a dilator, a #11 scalpel, an introducer needle, 1% lidocaine, several 3 and 5 mL syringes, several smaller needles (usually 20, 22, and 23 gauge), single straight-suture needle with suture, CVC clamp, dressing, gauze, drape, and chlorhexidine. Assemble the supplies including the CVC kit, sterile gown, sterile gloves, bonnet, mask, saline flushes, any special dressings or antibiotic barriers required at your institution. The procedure for placing any type of CVC is the same.ġ. For purposes of this discussion, we will place a triple-lumen CVC, as this is commonly needed when multiple different medications need to be delivered simultaneously. CVCs may have a single lumen, a double lumen, or a triple lumen. There are several types of CVC kits commonly available marketed by different manufacturers. Lastly, the guide wire is removed, and the catheter is sutured in place. Next, the needle is removed, a dilator is passed over the wire to dilate the skin and soft tissue, and the catheter is passed over the wire until it is appropriately positioned within the vessel. A guide wire is then passed thought the needle until it is appropriately positioned within the vessel. First, the subclavian vein is cannulated with an 18-gauge thin-walled needle. Successful placement of the subclavian CVC requires good working understanding of the target vessel anatomy as well as fluidity in performing the Seldinger procedure (an introduction of the catheter into a vessel over the guide wire, which is inserted through a thin-walled needle). ![]() In addition, in the event of an inadvertent arterial puncture, the access to the subclavian artery is impeded by the clavicle, which makes it difficult to effectively compress the vessel. The most significant disadvantage of the subclavian access is the risk of pneumothorax due to the anatomic proximity to the dome of the lung, which lies just superficial to the subclavian vein. Subclavian line can be placed quickly using anatomic landmarks and are often performed in trauma settings when cervical collars obliterate the access to the internal jugular (IJ) vein. The subclavian central venous catheter (CVC) placement is associated with lower infection and thrombosis rate than internal jugular and femoral CVC. There are three veins in the body that are accessed for central venous cannulation: the internal jugular, the subclavian, and the femoral vein.Ĭentral venous access via the subclavian vein has several advantages over other possible locations. Source: James W Bonz, MD, Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USAĬentral venous access is necessary in a multitude of clinical situations for hemodynamic monitoring, medication delivery, and blood sampling. ![]()
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