critical care medicine
How To Do Infraclavicular Subclavian Vein Cannulation
Contraindications
Absolute contraindications Subclavian vein thrombosis Fracture of the clavicle or proximal ribs Local infection at the insertion site Antibiotic-impregnated catheter in allergic patient Relative contraindications Unilateral lung disease: Cannulate ipsilaterally. Unilateral anatomic distortion, traumatic or congenital, without pneumothorax: Cannulate contralaterally. Cardiac pacemaker/defibrillator: Do not cannulate the vein being used for the pacemaker leads. Gross obesity: Because the axillary vein lies deep and the brachial plexus is nearby, cannulate the axillary vein only in thin patients. Young children and infants: Subclavian vein cannulation is the least preferred CVC for young children and infants because of unfavorable anatomy, including the vein’s close proximity to the pleura and subclavian artery. Coagulopathy, including therapeutic anticoagulation* Gross obesity Malignant superior vena cava syndrome Severe cardiorespiratory insufficiency or increased intracranial or intraocular pressure: These patients will be compromised by Trendelenburg (head down) positioning. History of prior catheterization of the intended central vein Uncooperative patient: Sedate if necessary. Left bundle branch block: A guidewire or catheter in the right ventricle can induce complete heart block. * Therapeutic anticoagulation (eg, for pulmonary embolism) increases the risk of bleeding with subclavian vein cannulation, but this must be balanced against the increased risk of thrombosis (eg, stroke) if anticoagulation is reversed. Discuss any contemplated reversal with the clinician managing the patient's anticoagulation and then with the patient. A How To Do Femoral Vein Cannulation may be preferred. 