Placing a Central Venous Catheter:

Choosing the Right Site

 

     There are a few places on the body where central venous access can be (more or less) easily attained.  In order to measure central venous pressure, the catheter tip should end up  just above, or at the junction of, the superior vena cava and the right atrium.  Where you insert the central venous catheter depends on the condition of the patient, their ability to stay in the position needed for cannulation, the experience of the operator, the equipment available, and what is desired; all sites have unique advantages and disadvantages.  Possible cannulation sites for central venous access include:

 

  • Basilic (arm) vein
  • Femoral vein
  • Subclavian vein
  • External jugular vein
  • Internal jugular vein

 

     Each site has its limitations and advantages; however, the right internal jugular vein (the “right I.J. ” as it is commonly referred to) is a very common used site for central venous cannulation due to a number of factors:

 

  • Ease of accessibility to the anesthesiologist during surgery
  • High success rate
  • Low rate of complications
  • Best for use of pulmonary artery catheters
  • Suitable for long-term use

 

     Disadvantages include the experience required to place a central venous catheter into the right IJ, and the possible complications during the procedure (see "Complications").   

 

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