Indications
- • Vasopressors / irritant infusions
- • CVP / ScvO₂ monitoring
- • Poor peripheral access
- • Renal replacement therapy (vascath)
- • TPN
Contraindications
- ⚠ Site infection / thrombosis
- ⚠ Coagulopathy (relative)
- ⚠ Distorted anatomy
Equipment
- • Full barrier precautions (cap, mask, gown, gloves)
- • USS with sterile sheath
- • CVC kit (multi-lumen, dilator, guidewire, scalpel)
- • Chlorhexidine, drapes, suture, dressing
- • Heparinised saline flushes
Technique
- • Trendelenburg, head turned away from cannulation side
- • USS-identify IJV (anterolateral to carotid, compressible)
- • Sterilise wide field, drape
- • Local anaesthetic over puncture site
- • USS-guided needle entry, dark venous blood — pass guidewire (ECG for arrhythmia)
- • Dilate tract, railroad catheter — usually 15 cm right IJ, 17 cm left
- • Aspirate + flush each lumen, suture and apply transparent dressing
- • Confirm tip position above carina + exclude pneumothorax on CXR
Complications
- ⚠ Arterial puncture / haematoma
- ⚠ Pneumothorax (esp subclavian)
- ⚠ Air embolism
- ⚠ Arrhythmia (wire too deep)
- ⚠ CRBSI, thrombosis
Aftercare
- • CXR before use (non-emergency)
- • Daily line review — remove ASAP
- • Aseptic technique for accessing
- • Document insertion site, depth, complications
Clinical pearls
- • Right IJ has straightest path to SVC
- • Use ECG guidance: P-wave changes indicate atrial tip
- • Subclavian = lowest infection risk, highest pneumothorax
Perform under supervision until competent. Follow local SOPs and consent policy.
