Central venous catheterisation

Subclavian Approach

• Postioning
• Right side preferred
• Supine position, head neutral, arm abducted
• Trendelenburg (10-15 degrees)
• Shoulders neutral with mild retraction
• Needle placement
• Junction of middle and medial thirds of clavicle
• At the small tubercle in the medial deltopectoral groove
• Needle should be parallel to skin
• Aim towards the suprasternal notch and just under the clavicle

Internal Jugular Approach

• Positioning
• Right side preferred
• Trendelenburg position
• Head turned slightly away from side of venipuncture
• Needle placement: central approach
• locate triangle formed by clavicle and sternal and clavicular heads of SCM
• Gently place three fingers of left hand on carotid artery
• Place needle at 30-40 degrees to the skin, lateral to the carotid artery
• Aim toward the ipsilateral nipple under the medial border of lateral head of SCM muscle
• Vein should be 1-1.5cm deep, avoid deep probing in the neck

Femoral Approach

Positioning

• Supine
• Needle placement
• Medial to femoral artery
• Needle held at 5 degree angle
• Skin insertion 2cm below inguinal ligament
• Aim towards umbilicus

Post -Catheter Placement

• Aspirate blood from each port
• Flush with saline or sterile water- heparinised
• Secure catheter with sutures
• Cover with sterile dressing
• Obtain chest Xray for IJ and SC lines
• Write procedure notes
• Tubings are changed per protocol- 72 hrs
• Caps and connections are changed per protocol- 3-7 days

NOTE:

• Get chest xray after unsuccesful attempt
• If attempt at one site fails,try a new site on same side to avoid bilateral complications
• If you meet resistance while inserting the guide wire, withdraw slightly and rotate the wire and re-advance
• Withdraw slowly