• Internal jugular and subclavian catheters have
certain advantages over femoral venous catheters, including the
• 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
• 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.