Internal Jugular Line Course - cont'd info

Contraindications for internal jugular venous catheter placement

• Patient refusal
• Deep venous thrombosis of vein
• Overlying burn or cellulitis
• Thrombocytopenia with platelets <20,000
• Anticoagulation is a relative contraindication for accessing a compressible vein 
• Inability to lie flat 

 

Complications of internal jugular venous catheter placement

• Central line-associated Bloodstream Infection (CLABSI) (femoral>IJ>subclavian)
• Deep venous thrombosis (femoral > IJ = subclavian)
• Pneumothorax (subclavian > IJ)
• Hemothorax (subclavian > IJ)
• Hematoma (femoral > subclavian = IJ)
• Arterial injury or arterial cannulation (femoral > IJ > subclavian)
• Bleeding (femoral > IJ > subclavian)
• Air embolus (IJ = subclavian)
• Dysrhythmias (IJ > subclavian)
• Lost guidewire 

Equipment for internal jugular venous catheter placement

• Cap
• Mask
• Sterile gown
• Sterile gloves
• Central line kit
• Biopatch (if available)
• Sterile occlusive dressing
• Sterile saline flushes
• Needleless caps
• Point of care ultrasound with linear array probe
• Sterile ultrasound sheath with sterile ultrasound gel and sterile rubber bands

Proper positioning and technique for internal jugular venous catheter placement

• • Trendelenberg position

• Turn neck slightly in contralateral direction

• Prep skin with chlorhexidine swab and allow at least 2 minutes to dry

• Wide sterile drape

• Apply sterile sheath over linear array probe

• Identify ideal insertion site with ultrasound probe

• Anesthetize skin and underlying soft tissue

• Advance introducer needle under real-time ultrasound guidance to cannulate IJ vein

• Stabilize needle hub and remove syringe

• Quickly advance wire about 20 cm through needle

• Remove needle leaving wire in place

• Use scalpel to nick skin

• Use dilator over wire to dilate subcutaneous tract

• Advance catheter over wire to appropriate depth of insertion

• Remove wire leaving catheter in place

• Flush all catheter ports with sterile saline

• Secure catheter in place with suture

• Apply biopatch at insertion site if available

• Apply sterile occlusive dressing

• CXR to confirm catheter tip placement

 

Coding for internal jugular venous catheter placement

 36556 – central venous catheter insertion

76937 – ultrasound guidance for vascular access