Central Venous Catheterization: Internal Jugular Approach (Training Physician)

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  • Administration of agents into the central vasculature
  • Central circulation and intracardiac access
  • Maintenance of venous access
  • Hemodialysis and plasmapheresis
  • 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
  • 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)
  • Internal jugular vein
    • Courses inferiorly between the two heads of the sternocleidomastoid muscle and joins the subclavian vein medial to the head of the clavicle
    • Anterior and lateral to the carotid artery
    • Right internal jugular preferable to the left
    • Central, anterior, and posterior approaches possible

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The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Confirmation of line placement
  • Dressing changes at least every 72 hours
  • Infection
  • Bleeding
  • Pneumothorax
  • Thrombosis
  • Air embolization
  • Arrhythmia
  • Myocardial perforation
  • Nerve injury
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