Central Line Anatomy

Introduction

Successful and safe insertion of a central venous catheter requires an understanding of the anatomic relationships associated with the larger veins of the body. These catheters can be used for fluid resuscitation, blood draws, hemodynamic monitoring, parental nutrition, and blood product administration. When bedside ultrasonography is used, these key anatomic relationships are even better observed during catheter placement. Ultrasound can be used to assist in assessing the patient, confirming safe catheter placement and reducing complications.

Venous Central Access Prepartion

There are numerous key factors for success in central venous access insertion. Any institution-recognized safety checklist and patient consent forms should always be completed. Refamiliarizing oneself with the anticipated anatomy provided by the figures in this chapter can assist with successful central line placement. There are key features for each specific central venous access approach. For the internal jugular and subclavian vein procedures, anatomy and identification of the central venous system is assisted by the Trendelenburg position. For all venous access procedures, proper sterile technique including chlorhexidine scrub and full body drape are necessary to reduce complications such as superficial, systemic, and line infections.

Procedural preparation should include a thorough review of preprocedural images such as plain chest radiography or prior venous ultrasounds. Additionally, bedside ultrasound can be used to access the vascular patency, anatomy, and surrounding deep tissue structural relationships. In the age of the electronic medical record, chart reviews of central access can also be completed with saved ultrasound anatomic images of successful venous access insertions.

Although numerous methods can be used for catheter insertion in the central venous system, this chapter focuses on the anatomy and details of the most commonly used techniques.