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Identifying a Vein for CVC Insertion

 
 
 
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Overview

  • Do

  • Think about the future plan for this patient, and whether this site will be needed for any other access
  • Don't

  • Don’t insert a needle through a burn, oedema or infected tissue
  • Don’t insert a CVC into an area with localised deformity, e.g. clavicular or femoral fracture
  • Don’t insert a subclavian CVC on the same side as a pacemaker
  • Don’t insert a subclavian CVC into a coagulopathic patient
  • Avoid a femoral CVC in a patient who is incontinent - especially of faeces

Internal Jugular Vein

  • Look

  • Between the two heads of the sternocleidomastoid muscle - ask the patient to turn their head.
To identify the vein using ultrasound, place the probe between the two heads of the sternocleidomastoid and look for a large-bore, non-pulsating, collapsible vessel lateral to the carotid artery.
  • Considerations

  • Use the right internal jugular vein where possible, due to its larger diameter and proximity to the superior vena cava.

Subclavian Vein

Identify the junction of the medial third and lateral two-thirds of the clavicle. The needle should be inserted 1cm inferior and lateral to this, pointing toward the sternal notch, upward and away from the underlying lung apex.
  • Considerations

  • Avoid in patients with clavicular fracture
  • Avoid in coagulopathic patients, as it is impossible to compress the artery if it is punctured
  • Avoid on the same side as a pacemaker

Femoral Vein

To identify the vein using ultrasound, place the probe in the groin over the femoral triangle, below the inguinal ligament. Look for a large-bore, non-pulsating, collapsible vessel medial to the femoral artery.
  • Considerations

  • Makes ambulation difficult
  • Preferred for coagulopathic patients, due to ability to compress the site
  • Higher risk of infection
  • Higher risk of thrombosis
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