• 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
• 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
• 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.
• Inform parents of the indications and risks of
• Inform parents about how long the catheter is likely to remain
• Inform parents in advance that their child may be sedated or
intubated for the procedure and what risks each incurs.
|• Because of the risks and potential complications, only
anesthesiologists, intensivists, some cardiologists, and surgeons
perform this procedure.|
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