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
- Soft tissue infection overlying site
- Traumatic or congenital distortions
- Superior vena cava syndrome
- Deep venous thrombosis in vessel of choice
- Coagulopathies
- Combative or uncooperative patients
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
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