Central Venous Catbeterization: A Comprehensive Review, Part II

Abstract

Address reprint requests to Dr Seneff at his present address.In Part I of this article, the indications and contraindications of central venous catheterization were reviewed, and the antecubital, external jugular, and femoral vein routes discussed. In Part II, the internal jugular and subclavian vein routes for central venous catheterization are reviewed, and an overview of catheter maintenance and infection control presented. The internal jugular vein and subclavian vein are the two most useful sites for central venous access. There is greater experience with the subclavian vein, and it is largely because of a perceived high complication rate associated with this approach that the internal jugular vein was cultivated as an access route in adults. The debate remains as to which route is preferable. In reality, each method has advantages in a given clinical situation. cava (SVC). In contradistinction, the left IJV joins the left SV at a near right angle, and any catheter inserted through the left IJV must negotiate this sharp turn [5][6][7][8].A knowledge of the anatomical structures neighboring the IJV is essential because they can be invaded by a misdirected needle. The ICA runs medial to the IJV. Behind the ICA, just outside the