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
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
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
Related Anatomy
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Related Differential Diagnoses
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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
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
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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