Central Venous Access via Tunneled Anterior Approach to Internal Jugular Vein Periprocedural Care

Updated: Sep 04, 2017
  • Author: Krishna Kumar Govindarajan, MBBS, MS, MCh, MRCS, DNB; Chief Editor: Vincent Lopez Rowe, MD  more...
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Periprocedural Care

Preprocedural Planning

In patients who need long-term venous access (eg, patients with a small-bowel transplant), imaging of the neck veins may be necessary before the procedure.

Doppler ultrasonography (US), magnetic resonance (MR) venography, or both can be used to establish venous patency and anatomy, thus improving planning and anticipation of potential problems with access. [3]

Particularly in patients with multiple medical problems, a complete blood count, clotting profile, and relevant renal and liver function tests should be included in the preprocedural workup. Depending on the platelet count, platelet transfusion may be needed.

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Equipment

Materials required for the procedure include the following:

  • Central venous catheter tray (line kit; see the images below)
  • Sterile gloves
  • Antiseptic solution with skin swab
  • Sterile drapes or towels
  • Sterile gown
  • Sterile saline flush, approximately 30 mL
  • Lidocaine 1%
  • Gauze
  • Dressing
  • Scalpel, No. 11
  • Vascular forceps (DeBakey)
  • Needle driver
  • Polypropylene suture 4/0
  • Steri-Strips
  • Mepore adhesive tape
Double-lumen tunneled line. Double-lumen tunneled line.
Hemocatheter. Hemocatheter.
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Patient Preparation

Anesthesia

A local anesthetic agent is used before the catheter is tunneled. For more information, see Local Anesthetic Agents, Infiltrative Administration.

Positioning

Trendelenburg position with the head turned to the side opposite the central venous line insertion is optimal (see the image below); the internal jugular vein (IJV) distends in this position, providing a maximal cross-sectional area for access. [4]  The ipsilateral arm should be extended minimally at the axilla. In adults, neutral position of the neck has been shown to be equally safe. [5]

Correct positioning of patient, with head down and Correct positioning of patient, with head down and turned to opposite side with roll under neck.
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