Central Venous Catheter

Indications

To obtain emergency access to central venous circulation

to monitor central venous pressure

to deliver high-concentration parenteral nutrition or prolonged IV therapy,

to infuse blood products or large volumes of fluid.

Complications

Infection, bleeding, arterial or venous laceration, pneumothorax, hemothorax, thrombosis, catheter fragment in circulation, air embolism, and atrioventricular fistula.

Access sites

External jugular vein.

Subclavian vein.

Internal jugular vein.

Femoral vein.

NOTE

Femoral vein catheterization is contraindicated in severe abdominal trauma, and internal jugular catheterization is contraindicated in patients with elevated intracranial pressure (ICP).

Procedure: The Seldinger technique

Secure patient, prepare site, and drape in sterile fashion.

Insert needle, applying negative pressure to locate vessel.

When there is blood return, insert a guidewire through the needle into the vein to about one fourth to one third of the length of the wire.

Remove the needle, holding the guidewire firmly.

Slip a catheter that has been preflushed with sterile saline over the wire into the vein in a twisting motion. The entry site may be enlarged with a small skin incision or dilator. Pass the entire catheter over the wire until the hub is at the skin surface. Slowly remove the wire, secure the catheter by suture, and attach IV infusion.

Apply a sterile dressing over the site.

For neck vessels, obtain a chest radiograph to rule out pneumothorax.

Approach

External jugular

Place patient in 15-to 20-degree angle Trendelenburg position. Turn the head 45 degrees to the contralateral side. Enter the vein at the point where it crosses the sternocleidomastoid muscle.

Internal jugular

Place patient in 15-to 20-degree angle Trendelenburg position

Hyperextend the neck to tense the sternocleidomastoid muscle, and turn head away from the site of line placement

Palpate the sternal and clavicular heads of the muscle and enter at the apex of the triangle formed

Insert the needle at a 30-degree angle to the skin and aim toward the ipsilateral nipple. When blood flow is obtained, continue with Seldinger technique.