Download Subclavian - ASTEC - University of Arizona

Procedural Skills for Medical Students
Central Line placement: Subclavian
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 Subclavian
central line on central line trainer, using sterile
technique.
Material to review prior to lab: Video on CVL placement, Subclavian (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:
1.
2.
3.
4.
5.
6.
7.
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, subclavian 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 subclavian central venous line.
3. Learners will demonstrate one subclavian central line insertion on trainer using sterile
technique with guidance from ASTEC staff.
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Procedural Skills for Medical Students
References:
Braner, D., Lai, S., Eman, S., & Tegtmeyer, K. (2007). Central venous catheterization –
subclavian vein. The New England Journal of Medicine, 357(e26). Retrieved from
http://www.nejm.org/doi/full/10.1056/NEJMvcm074357#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.
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