The Central Line Part 1: The Basics

a blog series on emergency medicine procedures

In this first installment on central lines, we discuss central line indications/contraindications/alternatives, anatomic considerations, and the upsides and downsides of the 3 major sites (subclavian, internal jugular, and femoral)

Indications specific to the ER

  • Administration of harsh or concentrated fluids
  • High volume, high flow fluid administration
  • Emergency venous access
    • Alternatives: EJ, IO, ultrasound-guided peripheral IV
  • Conduit for transvenous pacer or dialysis catheter

Contraindications

  1. Soft tissue infection overlying site
  2. Traumatic or congenital distortions
  3. Superior vena cava syndrome
  4. Deep venous thrombosis in vessel of choice
  5. Coagulopathies
  6. Combative or uncooperative patients

troubleshooting

TROUBLESHOOTING: How to solve the above contraindications…

  • 1-4: move to another site
  • 5: consider reversal agents
  • 6: consider sedation and/or intubation, depending on the case
LOCATION

SUBCLAVIAN

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From Netter’s Atlas of Human Anatomy, 4th ed, 2006 

Pathway

Subclavian vein and IJ –> brachiocephalic vein + contralateral brachiocephalic vein –> SVC

Where it is

Posterior to medial 1/3 of clavicle AND anterior to 1st rib

Anatomic awareness Continue reading