Editing Central line placement (section)

== '''Choice of site:''' ==

* Non-contaminated area that will stay clean
* Avoid altered local anatomy
* Avoid previous access device
* If significant lung disease is present, use the same side, to minimise risk of ruining good lung with a PTX


'''Advantages and disadvantages of central vein approaches'''
{| class="wikitable"
|'''Approach'''
|'''Advantages'''
|'''Disadvantages'''
|-
|External jugular
|
** Superficial vessel that is often visible
** Coagulopathy not prohibitive
** Minimal risk of pneumothorax (especially with US guidance)
** Head-of-table access
** Prominent in older adult patients
** Rapid venous access
|
** Not ideal for prolonged venous access
** Poor landmarks in patients with obesity
** High rate of malposition
** Catheter may be difficult to thread
|-
|Internal jugular
|
** Minimal risk of pneumothorax (especially with US guidance)
** Head-of-table access
** Procedure-related bleeding amenable to direct pressure
** Lower failure rate with novice operator
** Excellent target using US guidance
|
** Not ideal for prolonged access
** Risk of carotid artery puncture
** Uncomfortable
** Dressings and catheter difficult to maintain
** Thoracic duct injury possible on left
** Poor landmarks in patients with obesity/edematous patients
** Potential access and maintenance issues with concomitant tracheostomy
** Vein prone to collapse with hypovolemia
** Difficult access during emergencies when airway control being established
|-
|Subclavian
|
** Easier to maintain dressings
** More comfortable for patient
** Better landmarks in patients with obesity
** Accessible when airway control is being established
** Associated with lower incidence of catheter-related infection*[1]
|
** Increased risk of pneumothorax
** Procedure-related bleeding less amenable to direct pressure
** Decreased success rate with inexperience
** Longer path from skin to vessel
** Catheter malposition more common (especially right SCV)
** Interference with chest compressions
** Risk for stenosis/occlusion, which impacts future hemodialysis arteriovenous access
|-
|Femoral
|
** Rapid access with high success rate
** Does not interfere with CPR
** Does not interfere with intubation
** No risk of pneumothorax
** Trendelenburg position not necessary during insertion
|
** Delayed circulation of drugs during CPR
** Prevents patient mobilization
** Difficult to keep site sterile
** Difficult for PA catheter insertion
** Increased risk of iliofemoral thrombosis
|}
[[Category:Vascular]]