Download Central Line placement: Internal Jugular - ASTEC Lab

Procedural Skills for Medical Students
Central Line placement: Internal Jugular (IJ)
Objectives:
1. Learners should be able to verbalize the indications and
contraindications of central line placement.
2. Learners should be able to verbalize the ideal anatomical
location for placement of an internal jugular line.
3. Learners should be able to insert IJ central line on central
line trainer, using sterile technique.
Material to review prior to lab: Video on Central Venous
Catheterization and Ultrasound-Guided IJ Cannulation
(need access to New England Journal of Medicine, available to students through the
University of Arizona Health Sciences Library)
Indications:
1. Venous access in obese or debilitated patients who have peripheral veins that are
inaccessible for peripheral IV cannulation.
2. Emergency venous access after a cardiac arrest
3. Administration of cardiac medication during cardiopulmonary resuscitation
4. Large-volume parenteral fluid administration when peripheral IV cannulation is not
readily obtainable
5. Central venous pressure monitoring
6. Administration of certain chemotherapeutic agents, vasopressor medications, or
hyperosmolar infusions (i.e. total parenteral nutrition)
7. Performance of right cardiac catheterization and pulmonary angiography
8. Performance of hemodialysis or plasmapheresis
Contraindications:
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Patient refusal
Distortion of local anatomy or landmarks
Superior vena cava syndrome
Uncontrolled coagulopathy
Burn or cellulitis over insertion site
Venous thrombosis of the proposed site
Right-sided endocarditis or mural thrombus
Equipment: HPS, central line kit, IJ central line trainer
Instructional Procedure & Endpoints:
1. Learners will be oriented to trainer and equipment in ASTEC.
2. ASTEC staff or facilitator will demonstrate instruction on proper sterile technique for
insertion of internal jugular central venous line.
3. Learners will demonstrate one IJ central line insertion on trainer using sterile technique
with guidance from ASTEC staff.
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Procedural Skills for Medical Students
References:
Graham, A.S., Ozment, C., Tegtmeyer, K., Lai, S., & Braner, D. (2007). Central venous
catheterization. The New England Journal of Medicine, 356(e21). Retrieved from
http://www.nejm.org/doi/full/10.1056/NEJMvcm055053#figure=preview.gif
James, D. (2011). Central venous catheter insertion. In J.L. Pfenninger, & G.C. Fowler (Eds.),
Procedures for Primary Care, 3rd Ed (1443-1450). Philadelphia: Elsevier Mosby.
Ortega, R., Song, M., Hansen, C.J., & Barash, P. (2010). Ultrasound-guided internal jugular
vein cannulation. The New England Journal of Medicine, 362(e57). Retrieved from
http://www.nejm.org/doi/full/10.1056/NEJMvcm0810156#figure=preview.jpg
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