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Harman Gill
I am a proud Indian by ethnicity and Sikh by religion who lives in the lovely upper valley here in New Hampshire. I love to host, cook and engage in health conversations and loud debates where decibels can be raised but respect is never lost! Talk to you soon!
Matt Tyler
The Pre-brief
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.
The Debrief
Basics of conventional/landmark-based subclavian central lines:
- Anatomy: Placed at the junction of the medial and middle third of the clavicleÂ
- 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)Â
- 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 aboveÂ
- Risks: Same as above but less likely to cause pneumothorax as pleural line is under constant and direct visualizationÂ
- Procedure specifics: Watch the video!Â
- Literature supports the merits of this version of subclavian central line placement over the traditional, landmark based approachÂ
- Can be technically challenging
- Need to have strict control and visualization of the needle tip at all timesÂ
- Tips for troubleshooting…coming up next time!
