Morning Report: 10/2/2014

Thanks to Dr. Rolston-Cregler for today’s Morning Report!

 

Supraclavicular CVC Placement

  • First described in 1965 as an alternative method for obtaining central venous access
  • At the insertion site the subclavian vein is closer to the skin than using the infraclavicular subclavian vein approach
  • Insertion sites of the needle include
    • One centimeter lateral to the lateral border of the clavicular head of the SCM and one CM superior to the clavicle
    • One centimeter medial and one centimeter superior to the midpoint of the clavicle with the needle directed towards the ipsilateral SC joint
    • Just posterior to the clavicle at the junction of middle/medial third of the clavicle
  • Aspiration of air bubbles = pneumothorax = bad
    • On the bright side you’ll get to show off those amazing chest tube skills
  • Is usually done without ultrasonographic assistance but U/S can be used with the probe in long axis
    • Allows for identification of subclavian artery and lung pleura
  • http://www.aliem.com/trick-of-the-trade-ultrasound-guided-supraclavicular-central-line/
  • http://www.youtube.com/watch?v=I3Jqbxa1_Ts
  • http://emedicine.medscape.com/article/80355-overview#showall
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital

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