Clinical Procedure
Aliases:
Topic aliases are alternate phrasings for a particular topic.
Subclavian central venous line (CVL)
Subclavian CVC
Subclavian line
If performing subclavian central line, ensure coagulation and platelet function are normal. Inadvertant subclavian artery puncture is more difficult to tamponade than femoral or carotid puncture.
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Mar 02, 2012
-- Anatomical technique --
( only if an ultrasound is not available )
- Consent the patient
- Look at any recent CXRs. If there is any lung pathology insert the line on that side in the event a pneumothorax occurs, sparing the good lung.
- Soft padding between the scapulae to drop the shoulders out of the way.
- Position the patient up to 30 degrees head down to enlarge the vein ( as much as is comfortable for the patient ).
- Monitor with ECG, Oximetry and NIBP.
- Hudson mask with >6L/min oxygen to provide some gas under the drapes.
- Define your landmarks. Pick a spot 1/3rd along the line between the acromioclavicular line and the sternoclavicular joint.
- Gown, glove, and mask.
- Apply antiseptic prep generously and allow sufficient time to dry (at least 30 secs).
- Use a 5ml syringe with lignocaine with 23g seeker needle.
- Inserted at the mark, aim medially towards the sternoclavicular joint and ensure the needle is flat (to minimise the risk of pneumothorax). Aim to hit and walk off the underside of the clavicle, anaesthetising and aspirating as you go.
- Usual seldinger technique from this point on.
- CXR at the end to confirm correct tip positioning and rule out pneumothorax.
( only if an ultrasound is not available )
- Consent the patient
- Look at any recent CXRs. If there is any lung pathology insert the line on that side in the event a pneumothorax occurs, sparing the good lung.
- Soft padding between the scapulae to drop the shoulders out of the way.
- Position the patient up to 30 degrees head down to enlarge the vein ( as much as is comfortable for the patient ).
- Monitor with ECG, Oximetry and NIBP.
- Hudson mask with >6L/min oxygen to provide some gas under the drapes.
- Define your landmarks. Pick a spot 1/3rd along the line between the acromioclavicular line and the sternoclavicular joint.
- Gown, glove, and mask.
- Apply antiseptic prep generously and allow sufficient time to dry (at least 30 secs).
- Use a 5ml syringe with lignocaine with 23g seeker needle.
- Inserted at the mark, aim medially towards the sternoclavicular joint and ensure the needle is flat (to minimise the risk of pneumothorax). Aim to hit and walk off the underside of the clavicle, anaesthetising and aspirating as you go.
- Usual seldinger technique from this point on.
- CXR at the end to confirm correct tip positioning and rule out pneumothorax.
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Dec 17, 2012
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Good video tutorial from SonoAccess on the ultrasound guided subclavian central line insertion.
Also available on the manufacturers website.
cx1.sonosite.com/CentralV...
Also available on the manufacturers website.
cx1.sonosite.com/CentralV...
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Dec 16, 2012