• Emergency resuscitation requiring administration of large amounts of fluids.
• Need for central venous pressure monitoring.
• Placement of a pulmonary artery catheter.
• Need for frequent blood draws.
• Infusion of hyperalimentation.
• Infusion of agents that can extravasate and cause soft tissue necrosis.
• Concentrated solutions (ie, KCl, dextrose concentrations > 12.5%, chemotherapeutic agents, hyperosmolar saline).
• Vasoactive drugs (ie, dopamine and norepinephrine).
• Need for hemodialysis.
• Central access needed in a patient for which femoral vein catheterization is not possible due to poor landmarks or known thrombus.
| • Internal jugular and subclavian catheters are central lines placed percutaneously; they provide an alternative to femoral venous catheterization (see Chapter 10) when central venous access is needed. |
• Internal jugular and subclavian catheters have certain advantages over femoral venous catheters, including the following:
• A pulmonary artery catheter is placed more easily from the internal jugular vein because there is an almost a straight course to the superior vena cava and right atrium of the heart.
• Placement of a subclavian catheter uses a “blind” approach with good external landmarks; therefore, the operator may have more success in patients in shock or cardiopulmonary arrest where arterial pulsations are difficult to palpate.
• Catheters are minimally affected by ambulation and may be preferable in very mobile patients.
• Site of insertion is considered relatively “clean,” compared with the femoral location.
• Keep in mind that in a patient receiving anticoagulation therapy, bleeding can be controlled more easily using internal jugular puncture.
• However, there is a slightly higher incidence of failure using the internal jugular approach compared with the subclavian approach.
• Securing the catheter can be difficult in a child with a small neck.
• To avoid aspiration during intubation or conscious sedation, the procedure should be delayed 6 hours after the ingestion of solid food and 4 hours after the ingestion of clear liquids, unless central access is needed emergently.
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