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The most common indication is for the administration of chemotherapy or long-term parenteral nutritional support. For these purposes, a port is usually used. For short-term therapies, alternatives include a tunneled central venous catheter or a peripherally inserted central catheter (PICC).
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The procedure is usually performed as an outpatient. Electrolytes and clotting studies should be checked prior to the procedure. If the patient has had previous central catheters, a careful history should be obtained, as this will help with site selection. Transcutaneous ultrasound can assist with vein localization. A single dose of preoperative antibiotics provides for prophylaxis.
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Moderate sedation and local anesthesia is preferred.
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The patient is placed in the supine position. Fluoroscopy should be available. The arms are tucked at each side.
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The hair is removed with clippers. The chosen side of the neck/upper thorax are prepped and draped using the maximum sterile barrier technique.
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Internal Jugular Vein Access
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The internal jugular vein may be safer than subclavian venous access. The internal jugular vein is located posterior to the sternocleidomastoid mastoid muscle (Figure 1). It is usually accessed by a percutaneous route. The plate demonstrates a right internal jugular cannulation.
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Preliminary ultrasound of the right side of the neck is done in order to document the patency of the internal jugular vein. With real-time ultrasound guidance and employing a modified Seldinger technique, a small incision is made in the skin of the neck with a 15 blade and the internal jugular vein is cannulated with a small diameter needle (Figure 2A). After removing the syringe, the surgeon places a flexible guidewire (Figure 2B). The needle is removed, and over this wire, a 5-French dilator is placed to create a track (Figure 3). A 3- to 4-cm transverse incision is made on the upper right thorax two fingerbreadths below the clavicle and ...