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SAMPLE EXCERPT

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Billing Codes

CPT codes:

36557	Insertion of tunneled centrally inserted central venous catheter; younger than 5 years
36558	Insertion of tunneled centrally inserted central venous catheter; 5 years or older

ICD-9 codes:

89.62

Central Venous Catheterization: Internal Jugular Approach

INDICATIONS

CONTRAINDICATIONS

Absolute contraindications
- Adequate peripheral IV access. See Intravenous Cannulation for further details.
- Operator inexperience
- Uncooperative patient
Relative contraindications
- Significant uncorrectable bleeding disorder or administration of thrombolytic medication
- Injury or thrombosis in the target vessel or SVC
- Inability to tolerate pneumothorax
- Assisted ventilation with high end-expiratory pressure
Contraindications unique to the internal jugular approach
- Distortion of neck anatomy
- Cervical spine injuries
- Carotid atherosclerosis

EQUIPMENT

Central venous catheterization kit:
- Clear fenestrated plastic drape
- Paper drape
- Chlorhexidine antiseptic with applicators
- 1% Lidocaine
- Small anesthetizing needle (25 gauge × 1 inch)
- Large anesthetizing/finder needle (22 gauge × 1.5 inch)
- Introducer needle (18 gauge × 2.5 inch)
- Several syringes, 5 mL each
- J-tipped guidewire with housing and a straightener sleeve
- Scalpel with a No. 11 blade
- Skin dilator
- Catheter (e.g., triple lumen or sheath introducer)
- Gauze pads
- Suture with curved needle
- Disposable needle holder
Sterile gloves, sterile gown, cap, and mask with fluid shield for each member of the insertion team **STERILE TECHNIQUE** **UNIVERSAL PRECAUTIONS**
Large sterile drape (half-sheet)
Extra 1% lidocaine in sterile saline suitable for injection
Sterile dressing (e.g., Tegaderm, 3M Corporation, Huntingdon Valley, PA)

ANATOMY

Internal jugular vein
- Courses inferiorly between the two heads of the sternocleidomastoid muscle and joins the subclavian vein medial to the head of the clavicle³
- Anterior and lateral to the carotid artery
- Right internal jugular preferable to the left
- Central, anterior, and posterior approaches possible