centrallineinsertiontechniques.ppt

Central Line Insertion Techniques Jerome E Granato MD Department of Medicine Allegheny General Hospital May 2005 Central Line Insertion Techniques:Teaching Modules Anatomic Considerations Pre Procedure Issues Internal Jugular Puncture Subclavian Vein Puncture Recognizing Procedural Complications Radiographic Abnormalities Reducing The Risk Of Infection Multiple Choice Exam Mannequin Training Anatomic Considerations Internal jugular veins and subclavian veins are commonly used to obtain access to the central venous system. The right internal jugular vein is generally preferred over the left internal jugular vein given the relatively straight approach to the superior vena cava. Anatomic Considerations The internal jugular vein is a relatively superficial structure, lying anterior and lateral to the carotid artery. The thoracic duct lies in close proximity to the left internal jugular vein. Inadvertent puncture of this structure can lead to chylothorax. The apex of the lung is found posterior to the subclavian and internal carotid arteries. Anatomic Considerations The subclavian vein extend from the lateral border of the first rib to the sternoclavicular joint where it joins the internal jugular vein. The subclavian vein sits beneath the clavicle and superior to the subclavian artery. A pair of valves is not uncommon at the termination of the subclavian vein. Note the proximity of the subclavian vein to the phrenic nerve bilaterally. Anatomic Considerations Access to the internal jugular vein can be gained by proper identification of the sternal and clavicular heads of the sternocleidomastoid muscle. Note the proximity of the trachea and esophagus. Anatomic Considerations Access to the subclavian vein can be gained by proper identification of the window formed by the coracoid process, first rib, and medial 1/3 of the clavicle Pre Procedure Issues Prior to beginning the procedure, be sure that it is indicated. Unless it is an emergency, prior discussion wi