Ultrasound-Guided Central Venous Access

Abstract

PERIPHERAL UPPER extremity veins are often not available because of previous use and sclerosis or an extended body habitus. More concentrated and caustic compounds have found increased application in the treatment of disease. Use of peripheral extremity veins does not provide sufficient blood flow rates to dilute these chemotherapeutic agents to noncaustic concentrations. Fears of extravasation with resultant local tissue toxic effects have forced a migration to use of central venous access. As a result, central venous access has become a mainstay of patient care. In the surgical community, central venous access is achieved routinely by a percutaneous route. Using the anatomic landmarks of the clavicle, deltopectoral groove, sternal notch, and sternocleidomastoid muscle, the subclavian and internal jugular veins can be accessed, with reported success rates from 67% to 96%.^1-3