Central Lines can be very difficult to place. True central lines are the subclavian line and the internal jugular line. There is also the provision for insertion of a femoral. Subclavian lines can be easier to establish as the subclavian vein is a permanently distended vessel that is relatively easy to cannulate. There can be contraindications, or situations that make the subclavian difficult. Apart from direct trauma to the area, one of the most common reasons for inserting an internal jugular, is potential coagulopathy. The IJ gives us the ability to apply compression forces, whereas the subclavian, which passes under the clavicle, is protected by bone and there is very little provision for direct compression to stop bleeding. The use of ultrasound as shown in this video, allows us to clearly see the compressible vein and also us to see the point of insertion of the needle, in the vessel. This is a very safe technique and relatively simple to master. It has the benefit of allowing you to directly see entry into the vein, as well as minimising the incidence of pneumothoraces.
This will be one of many procedures that can be practiced at RESUS 2010. This is really shaping up to be a great conference, with attendees joining from all over the country. I look forward to seeing you there.