Internal Jugular vs Subclavian Temporary Central Lines... In Today’s ICU, Which is Actually Superior?
two authors argue opposing sides of IJ vs Subclavian in the modern critical care era.The debate between achieving temporary central venous access via the subclavian or internal jugular (IJ) approaches has waxed and waned. While blind subclavian and IJ approaches for years were the basis of medicine training, with the advent of point-of-care (POC) bedside ultrasound, the known complications of arterial puncture decreased during IJ approaches, making the procedure safer. For this reason, many have argued that the relatively stable risk of traumatic needle pneumothorax from blind subclavian lines is greater than the risk now of complication from ultrasound guided IJ lines. Whether the infection rates are comparable, or even the procedural complication rates, is up for debate. Here Read More »
Subclavian Central Lines: Reduced Infection and Thrombosis Risk
While central line insertion is necessary for many critically ill patients in the emergency department and ICU alike, placement of central lines is also associated with a high rate of complications, including mechanical complications, thrombosis, and infection. Appropriate selection of the subclavian, internal jugular (IJ) or femoral site, along with training in safe technique and use of checklists, are important to mitigate the risks of this common procedure. Recent data suggest that for many patients, the subclavian approach is the safest.Read More »
Over the last ten years, the wide adoption of ultrasound guidance has dramatically changed the risk associated with IJ central line placements, improving the safety and reducing mechanical complications.1 However, not all patients are candidates for IJ lines, such as patients in cervical collars, those with obese necks, and some neurosurgical patients. Additionally, despite the short-term safety of the ultrasound-guided IJ line placement, questions remain regarding the longer term effects of IJ catheterization.