arrow_backSubclavian venous catheter insertion
Position patient in the supine or Trendelenburg position.
Prep patient with chloroprep
Put on sterile gown and drape area with sterile towels
Use 25 gauge needle and 1% lidocaine to make wheal 2cm below the midclavicular line.
Then use larger needle (22 gauge) to anesthetize the deeper tissues.
Next use large bore venipuncture needle attached to a syringe. Gradually walk the needle down the clavicle until you are beneath it. Advance the needle aspirating as you go. Aim for a position halfway between the sternal notch and the thyroid cartilage. The vein is usually 2 finger breaths lateral to the sternal notch.
Once you get a flash of blood, use seldinger technique to advance the guide wire. Never let go of the guide wire and watch monitor for ventricular arrhythmias. Pull the wire out several centimeters if arrhythmias are present.
Withdraw the needle, but don’t let go of the guide wire!!
Nic the skin at the insertion site and insert the dilator 5cm.
Remove the dilator and insert the catheter over the guide wire.
Remove the guide wire and attach the IV tubing to the catheter.
Flush each catheter port with heparinized saline.
Suture catheter in place with 2.0 or 3.0 silk
Apply topical antibiotics to incision site.
Clean area and apply tegaderm over catheter
Get chest xray
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