Emergency Medicine

CENTRAL LINE INSERTION

Practical Procedures 477

3 Overlying skin cellulitis or burn.

4 Pneumothorax on opposite side (particularly subclavian insertion – use
same side).

5 Uncorrected bleeding diathesis (particularly subclavian line, as not able to
compress).

TECHNIQUE

1 Common sites are the internal jugular vein (IJV), subclavian vein (SCV) and
femoral vein. All are all located close to arteries and nerves that may be
damaged by a misplaced needle.
(i) In addition the SCV lies near the pleura of the lung with a greater
risk of pneumothorax.

2 Similar basic principles, techniques and equipment are required for each
site. Specific anatomical considerations and complications for each site are
described below (see Fig. 18.3).

Figure 18.3 Central line insertion.