What are the surgical pearls for central venous access via the subclavian vein?

Updated: Aug 07, 2018
  • Author: E Jedd Roe, lll, MD, MBA, FACEP, FAAEM, MSF, CPE; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Points that should be kept in mind to facilitate the performance of the procedure include the following:

  • The key to a successful line placement is meticulous preparation and setup before starting or donning sterile garb
  • Prepare a sterile site from the jaw to several fingerbreadths below the clavicle
  • The amount of lidocaine provided in most kits is often inadequate; the authors recommend supplementing the kit with a 10-mL syringe and a bottle of 1% lidocaine
  • If the wire does not pass easily through the needle down the vein, remove the wire, reattach the syringe, and confirm that the needle is still in the lumen of the vein before reattempting
  • Beware a return of red pulsatile blood; if this occurs, the wire is in an artery.
  • Beware aspirating air bubbles through the probing introducer needle; this indicates a pneumothorax (see Tube Thoracostomy)
  • Anesthetize the suture site as well as the insertion site
  • Some clinicians find it useful to remove the contents of the line kit and lay them out in the order and configuration that they will be used
  • Never place equipment on a patient
  • Antibiotic ointments are contraindicated; transparent dressings are not beneficial
  • Choose the central line with the fewest number of lumina required; increasing the number of lumina has been shown to increase infection rates [13]

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