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KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Definitions
- Seldinger technique: Needle puncture with subsequent guidewire introduction into vessel through needle; needle exchanged for sheath/catheter over wire
- Available access routes
- Jugular vein access: Most frequent access site for procedures and catheter placements
- Internal jugular (IJ) typically preferable to external jugular
- External jugular often enlarged in cases of IJ occlusion
- Right is preferable to left
- Shortest distance to central veins for catheter placement
- Most direct path to superior vena cava (SVC), right heart, and pulmonary vasculature
- Direct path to inferior vena cava (IVC)
- Anatomically most suitable route for hepatic vein access
- Common femoral vein access: 2nd most common after IJ access
- Can be accessed without US guidance by targeting medial to arterial pulse
- Safe access for placement of central venous and hemodialysis catheters, but higher catheter infection rates vs. jugular venous access
- Preferable access for some procedures (e.g., May-Thurner, iliocaval thrombolysis, antegrade IJ access, e.g., petrosal sinus sampling)
- Extracorporeal oxygenation
- Subclavian vein access: Least preferred site for upper central access
- Highest rate of pneumothorax
- Prone to symptomatic stenosis/thrombosis
- Postprocedure stenosis may affect dialysis venous outflow from upper extremity fistula/graft if required in future
- Vein is nonpalpable and cannot be compressed to secure hemostasis
- Basilic/cephalic/brachial vein access
- Most common access site for peripherally inserted central catheter (PICC)
- Favorable procedure access for venous recanalization (e.g., Paget-Schroetter)
- Popliteal vein access
- Favorable for diagnostic lower extremity/pelvic venogram
- Access site for iliofemoral deep vein thrombosis (DVT) thrombolysis procedures ± popliteal vein thrombosis
- Greater/lesser saphenous vein (GSV/LSV) access
- Access site for venous insufficiency/varicose vein treatment
- Alternative access site for DVT thrombolysis procedures for iliofemoral ± popliteal vein thrombosis
- Translumbar IVC access
- Salvage central venous access site for infusion therapy and dialysis access for patients with SVC/infrarenal IVC occlusion
- Risk of right ureter and kidney injury
- Transhepatic access
- Central venous and dialysis access for patients with SVC/infrarenal IVC occlusion
- Portal/mesenteric interventions
- Jugular vein access: Most frequent access site for procedures and catheter placements
- Available access routes
- Seldinger technique: Needle puncture with subsequent guidewire introduction into vessel through needle; needle exchanged for sheath/catheter over wire
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Positions/Location
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Management of Complications
Expected Outcomes
Selected References
- El Khudari H et al: Hemodialysis catheters: update on types, outcomes, designs and complications. Semin Intervent Radiol. 39(1):90-102, 2022
- Tran QK et al: Nurses and efficacy of ultrasound-guided versus traditional venous access: a systemic review and meta-analysis. J Emerg Nurs. 48(2):145-58.e1, 2022
- Wang P et al: Risk of VTE associated with PORTs and PICCs in cancer patients: a systematic review and meta-analysis. Thromb Res. 213:34-42, 2022
- Saugel B et al: Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 21(1):225, 2017
- Rafiei P et al: Society of Interventional Radiology IR pre-procedure patient safety checklist by the Safety and Health Committee. J Vasc Interv Radiol. 27(5):695-9, 2016
- Bouaziz H et al: Guidelines on the use of ultrasound guidance for vascular access. Anaesth Crit Care Pain Med. 34(1):65-9, 2015
- Brass P et al: Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev. 1:CD011447, 2015
- Yoon DY et al: Inadvertent arterial placement of central venous catheters: diagnostic and therapeutic strategies. Ann Vasc Surg. 29(8):1567-74, 2015
- AIUM practice guideline for the use of ultrasound to guide vascular access procedures. J Ultrasound Med. 32(1):191-215, 2013
- American Society of Anesthesiologists Task Force on Central Venous Access. et al: Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 116(3):539-73, 2012
- Patel IJ et al: Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 23(6):727-36, 2012
- Denny DF Jr: Venous access salvage techniques. Tech Vasc Interv Radiol. 14(4):225-32, 2011
- Rabindranath KS et al: Ultrasound use for the placement of haemodialysis catheters. Cochrane Database Syst Rev. CD005279, 2011
- Chemelli AP et al: Endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. J Vasc Interv Radiol. 21(4):470-6, 2010
- Lorenz JM et al: Transhepatic guidance of translumbar hemodialysis catheter placement in the setting of chronic infrarenal IVC occlusion. Cardiovasc Intervent Radiol. 33(3):635-8, 2010
- Blaivas M et al: An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance. Crit Care Med. 37(8):2345-9; quiz 2359, 2009
- Kariya S et al: Percutaneous translumbar inferior vena cava cannulation under computed tomography guidance. Jpn J Radiol. 27(4):176-9, 2009
- Phelan M et al: The oblique view: an alternative approach for ultrasound-guided central line placement. J Emerg Med. 37(4):403-8, 2009
- Sigaut S et al: Ultrasound guided internal jugular vein access in children and infant: a meta-analysis of published studies. Paediatr Anaesth. 19(12):1199-206, 2009
- Turker G et al: Internal jugular vein cannulation: an ultrasound-guided technique versus a landmark-guided technique. Clinics (Sao Paulo). 64(10):989-92, 2009
- Boon JM et al: Central venous catheterization--an anatomical review of a clinical skill. Part 2. Internal jugular vein via the supraclavicular approach. Clin Anat. 21(1):15-22, 2008
- Malcom GE 3rd et al: Difficult central line placement due to variant internal jugular vein anatomy. J Emerg Med. 35(2):189-91, 2008
- Bishop L et al: Guidelines on the insertion and management of central venous access devices in adults. Int J Lab Hematol. 29(4):261-78, 2007
- Boon JM et al: Central venous catheterization -- an anatomical review of a clinical skill -- Part 1: subclavian vein via the infraclavicular approach. Clin Anat. 20(6):602-11, 2007
- Mirski MA et al: Diagnosis and treatment of vascular air embolism. Anesthesiology. 106(1):164-77, 2007
- Thompson EC et al: Safe subclavian vein cannulation. Am Surg. 71(2):180-3, 2005
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Definitions
- Seldinger technique: Needle puncture with subsequent guidewire introduction into vessel through needle; needle exchanged for sheath/catheter over wire
- Available access routes
- Jugular vein access: Most frequent access site for procedures and catheter placements
- Internal jugular (IJ) typically preferable to external jugular
- External jugular often enlarged in cases of IJ occlusion
- Right is preferable to left
- Shortest distance to central veins for catheter placement
- Most direct path to superior vena cava (SVC), right heart, and pulmonary vasculature
- Direct path to inferior vena cava (IVC)
- Anatomically most suitable route for hepatic vein access
- Common femoral vein access: 2nd most common after IJ access
- Can be accessed without US guidance by targeting medial to arterial pulse
- Safe access for placement of central venous and hemodialysis catheters, but higher catheter infection rates vs. jugular venous access
- Preferable access for some procedures (e.g., May-Thurner, iliocaval thrombolysis, antegrade IJ access, e.g., petrosal sinus sampling)
- Extracorporeal oxygenation
- Subclavian vein access: Least preferred site for upper central access
- Highest rate of pneumothorax
- Prone to symptomatic stenosis/thrombosis
- Postprocedure stenosis may affect dialysis venous outflow from upper extremity fistula/graft if required in future
- Vein is nonpalpable and cannot be compressed to secure hemostasis
- Basilic/cephalic/brachial vein access
- Most common access site for peripherally inserted central catheter (PICC)
- Favorable procedure access for venous recanalization (e.g., Paget-Schroetter)
- Popliteal vein access
- Favorable for diagnostic lower extremity/pelvic venogram
- Access site for iliofemoral deep vein thrombosis (DVT) thrombolysis procedures ± popliteal vein thrombosis
- Greater/lesser saphenous vein (GSV/LSV) access
- Access site for venous insufficiency/varicose vein treatment
- Alternative access site for DVT thrombolysis procedures for iliofemoral ± popliteal vein thrombosis
- Translumbar IVC access
- Salvage central venous access site for infusion therapy and dialysis access for patients with SVC/infrarenal IVC occlusion
- Risk of right ureter and kidney injury
- Transhepatic access
- Central venous and dialysis access for patients with SVC/infrarenal IVC occlusion
- Portal/mesenteric interventions
- Jugular vein access: Most frequent access site for procedures and catheter placements
- Available access routes
- Seldinger technique: Needle puncture with subsequent guidewire introduction into vessel through needle; needle exchanged for sheath/catheter over wire
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Positions/Location
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Management of Complications
Expected Outcomes
Selected References
- El Khudari H et al: Hemodialysis catheters: update on types, outcomes, designs and complications. Semin Intervent Radiol. 39(1):90-102, 2022
- Tran QK et al: Nurses and efficacy of ultrasound-guided versus traditional venous access: a systemic review and meta-analysis. J Emerg Nurs. 48(2):145-58.e1, 2022
- Wang P et al: Risk of VTE associated with PORTs and PICCs in cancer patients: a systematic review and meta-analysis. Thromb Res. 213:34-42, 2022
- Saugel B et al: Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 21(1):225, 2017
- Rafiei P et al: Society of Interventional Radiology IR pre-procedure patient safety checklist by the Safety and Health Committee. J Vasc Interv Radiol. 27(5):695-9, 2016
- Bouaziz H et al: Guidelines on the use of ultrasound guidance for vascular access. Anaesth Crit Care Pain Med. 34(1):65-9, 2015
- Brass P et al: Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev. 1:CD011447, 2015
- Yoon DY et al: Inadvertent arterial placement of central venous catheters: diagnostic and therapeutic strategies. Ann Vasc Surg. 29(8):1567-74, 2015
- AIUM practice guideline for the use of ultrasound to guide vascular access procedures. J Ultrasound Med. 32(1):191-215, 2013
- American Society of Anesthesiologists Task Force on Central Venous Access. et al: Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 116(3):539-73, 2012
- Patel IJ et al: Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 23(6):727-36, 2012
- Denny DF Jr: Venous access salvage techniques. Tech Vasc Interv Radiol. 14(4):225-32, 2011
- Rabindranath KS et al: Ultrasound use for the placement of haemodialysis catheters. Cochrane Database Syst Rev. CD005279, 2011
- Chemelli AP et al: Endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. J Vasc Interv Radiol. 21(4):470-6, 2010
- Lorenz JM et al: Transhepatic guidance of translumbar hemodialysis catheter placement in the setting of chronic infrarenal IVC occlusion. Cardiovasc Intervent Radiol. 33(3):635-8, 2010
- Blaivas M et al: An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance. Crit Care Med. 37(8):2345-9; quiz 2359, 2009
- Kariya S et al: Percutaneous translumbar inferior vena cava cannulation under computed tomography guidance. Jpn J Radiol. 27(4):176-9, 2009
- Phelan M et al: The oblique view: an alternative approach for ultrasound-guided central line placement. J Emerg Med. 37(4):403-8, 2009
- Sigaut S et al: Ultrasound guided internal jugular vein access in children and infant: a meta-analysis of published studies. Paediatr Anaesth. 19(12):1199-206, 2009
- Turker G et al: Internal jugular vein cannulation: an ultrasound-guided technique versus a landmark-guided technique. Clinics (Sao Paulo). 64(10):989-92, 2009
- Boon JM et al: Central venous catheterization--an anatomical review of a clinical skill. Part 2. Internal jugular vein via the supraclavicular approach. Clin Anat. 21(1):15-22, 2008
- Malcom GE 3rd et al: Difficult central line placement due to variant internal jugular vein anatomy. J Emerg Med. 35(2):189-91, 2008
- Bishop L et al: Guidelines on the insertion and management of central venous access devices in adults. Int J Lab Hematol. 29(4):261-78, 2007
- Boon JM et al: Central venous catheterization -- an anatomical review of a clinical skill -- Part 1: subclavian vein via the infraclavicular approach. Clin Anat. 20(6):602-11, 2007
- Mirski MA et al: Diagnosis and treatment of vascular air embolism. Anesthesiology. 106(1):164-77, 2007
- Thompson EC et al: Safe subclavian vein cannulation. Am Surg. 71(2):180-3, 2005
