Central Venous Catheter (IJV) Procedure

Overview

• The Emergency Procedures team presents a detailed guide on the Internal Jugular Central Venous Catheter (IJV).
• The procedure is considered a core skill for Emergency Medicine doctors.
• Detailed written instructions are available via a Free App on iOS and Android.

Types of Central Lines

• Ultrasound-guided internal jugular (IJ) or femoral lines are crucial for emergency medicine.
  • Right IJ route is the preferred site for central venous catheter insertion.
  • Femoral route: Useful when IJ access is not feasible (e.g., patient not able to lie supine).
  • Subclavian lines: Higher risk and difficulty, used by experienced doctors in specific cases.

Ultrasound Guidance

• Real-time ultrasound guidance is essential for:
  • Increasing success rates.
  • Reducing complications.
  • Confirming anatomy and vessel patency.
• Techniques reduce infection rates with sterile probe covers and gels.

Ultrasound Techniques

• Short-axis vs Long-axis:
  • Short-axis: Easier, shows surrounding anatomy, better for beginners and in cases of obesity.
  • Long-axis: Allows full visualization of the needle, reduces risk of penetrating posterior wall.
• Needle insertion:
  • Shallow angle recommended for better ultrasound visibility.
  • Bevel downward reduces risk of posterior wall puncture.

Venous Access Methods

• Options: Thin-walled introducer needle or cannula-over-needle.
• Recommendation: Thin-walled needle for higher first-pass success and lower complications.

Guidewire Handling

• Always maintain control of one end of the wire.
• Ensure correct placement:
  • Visualize the guidewire in two planes.
  • Avoid malpositioning in incorrect vessels.
  • Retract and restart if wire position is uncertain.

Post-placement Checks

• Right IJ CVC placement:
  • Insert to 15 cm for proper positioning.
  • Adjust depth for patient size (Height/10 for larger patients).
• Confirm catheter tip with a chest X-ray.

Feedback and Improvements

• The team encourages suggestions for improving the video and guide.
• Contact via email.

Additional Resources

• Authors: Dr. James Miers, Dr. John Mackenzie.
• General course library available on Medmastery.