In this post, we will discuss the fundamental differences between the traditional landmark-based subclavian central line placement technique versus ultrasound-guided subclavian/axillary central line placement.
Basics of conventional/landmark-based subclavian central lines:
- Anatomy: Placed at the junction of the medial and middle third of the clavicle
- Indications: Central venous access, infusion of vasoactive/caustic infusions, hemodynamic monitoring (namely CVP)
- Risks: Bleeding, pneumothorax, and infection (although subclavian lines are considered to be least infection-prone)
- Procedure: Watch the video!
Basics of ultrasound guided subclavian/axillary central line:
- Anatomy: Placed anywhere the axillary/subclavian vein is visualized with ultrasound
- Indications: Same as above
- Risks: Same as above but less likely to cause pneumothorax as pleural line is under constant and direct visualization
- Procedure specifics: Watch the video!
- Literature supports the merits of this version of subclavian central line placement over the traditional, landmark based approach
- Can be technically challenging
- Need to have strict control and visualization of the needle tip at all times
- Tips for troubleshooting…coming up next time!