link
Bookmarks
Venous Access
Anatoly Loskutov, MD; Brandt C. Wible, MD
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Log inSubscribe

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 typically preferable to external jugular
                    • External jugular often enlarged in cases of internal jugular 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 & hemodialysis catheters, but higher catheter infection rates vs. jugular venous access
                    • Preferable access for some procedures (e.g., May-Thurner, iliocaval thrombolysis, antegrade internal jugular 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 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

                                      1. 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
                                      2. Bouaziz H et al: Guidelines on the use of ultrasound guidance for vascular access. Anaesth Crit Care Pain Med. 34(1):65-9, 2015
                                      3. Brass P et al: Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev. 1:CD011447, 2015
                                      4. Yoon DY et al: Inadvertent arterial placement of central venous catheters: diagnostic and therapeutic strategies. Ann Vasc Surg. 29(8):1567-74, 2015
                                      5. AIUM practice guideline for the use of ultrasound to guide vascular access procedures. J Ultrasound Med. 32(1):191-215, 2013
                                      6. 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
                                      7. Denny DF Jr: Venous access salvage techniques. Tech Vasc Interv Radiol. 14(4):225-32, 2011
                                      8. Rabindranath KS et al: Ultrasound use for the placement of haemodialysis catheters. Cochrane Database Syst Rev. CD005279, 2011
                                      9. Chemelli AP et al: Endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. J Vasc Interv Radiol. 21(4):470-6, 2010
                                      10. 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
                                      11. 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
                                      12. Kariya S et al: Percutaneous translumbar inferior vena cava cannulation under computed tomography guidance. Jpn J Radiol. 27(4):176-9, 2009
                                      13. Phelan M et al: The oblique view: an alternative approach for ultrasound-guided central line placement. J Emerg Med. 37(4):403-8, 2009
                                      14. 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
                                      15. 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
                                      16. 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
                                      17. Malcom GE 3rd et al: Difficult central line placement due to variant internal jugular vein anatomy. J Emerg Med. 35(2):189-91, 2008
                                      18. 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
                                      19. 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
                                      20. Mirski MA et al: Diagnosis and treatment of vascular air embolism. Anesthesiology. 106(1):164-77, 2007
                                      21. Thompson EC et al: Safe subclavian vein cannulation. Am Surg. 71(2):180-3, 2005
                                      Related Anatomy
                                      Loading...
                                      Related Differential Diagnoses
                                      Loading...
                                      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 typically preferable to external jugular
                                                        • External jugular often enlarged in cases of internal jugular 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 & hemodialysis catheters, but higher catheter infection rates vs. jugular venous access
                                                        • Preferable access for some procedures (e.g., May-Thurner, iliocaval thrombolysis, antegrade internal jugular 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 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

                                                                          1. 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
                                                                          2. Bouaziz H et al: Guidelines on the use of ultrasound guidance for vascular access. Anaesth Crit Care Pain Med. 34(1):65-9, 2015
                                                                          3. Brass P et al: Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev. 1:CD011447, 2015
                                                                          4. Yoon DY et al: Inadvertent arterial placement of central venous catheters: diagnostic and therapeutic strategies. Ann Vasc Surg. 29(8):1567-74, 2015
                                                                          5. AIUM practice guideline for the use of ultrasound to guide vascular access procedures. J Ultrasound Med. 32(1):191-215, 2013
                                                                          6. 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
                                                                          7. Denny DF Jr: Venous access salvage techniques. Tech Vasc Interv Radiol. 14(4):225-32, 2011
                                                                          8. Rabindranath KS et al: Ultrasound use for the placement of haemodialysis catheters. Cochrane Database Syst Rev. CD005279, 2011
                                                                          9. Chemelli AP et al: Endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. J Vasc Interv Radiol. 21(4):470-6, 2010
                                                                          10. 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
                                                                          11. 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
                                                                          12. Kariya S et al: Percutaneous translumbar inferior vena cava cannulation under computed tomography guidance. Jpn J Radiol. 27(4):176-9, 2009
                                                                          13. Phelan M et al: The oblique view: an alternative approach for ultrasound-guided central line placement. J Emerg Med. 37(4):403-8, 2009
                                                                          14. 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
                                                                          15. 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
                                                                          16. 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
                                                                          17. Malcom GE 3rd et al: Difficult central line placement due to variant internal jugular vein anatomy. J Emerg Med. 35(2):189-91, 2008
                                                                          18. 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
                                                                          19. 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
                                                                          20. Mirski MA et al: Diagnosis and treatment of vascular air embolism. Anesthesiology. 106(1):164-77, 2007
                                                                          21. Thompson EC et al: Safe subclavian vein cannulation. Am Surg. 71(2):180-3, 2005