Compared to the left, the right IJ forms a more direct path to the superior vena cava (SVC) and right atrium. Still, all things being equal, many clinicians prefer the right IJ.

The individual clinical scenario may dictate laterality in some cases (such as with trauma, head and neck cancer, or the presence of other invasive devices or catheters). The internal jugular vein (IJ) is often chosen for its reliable anatomy, accessibility, low complication rates, and ability to employ ultrasound guidance during the procedure. While the evidence does not suggest only one place, each location has known risks and benefits. Each anatomical site has relative advantages and disadvantages, and one spot is unlikely to be the best choice for every patient. The decision of where to place a central line is typically based on clinical parameters and individual clinician experience and preference. Understanding the relevant anatomy and adjacent structures is crucial when placing a CVC. We will focus on the three main sites of access routinely used for short-term (days to weeks) central access. A discussion of tunneled catheters and other central access obtained via advanced interventional radiology techniques is beyond the scope of this article. Additionally, for mid-term and long-term central venous access, the basilic and brachial veins are utilized for peripherally inserted central catheters (PICCs). These are the preferred sites for temporary prominent venous catheter placement. There are three main access sites for the placement of central venous catheters, namely internal jugular, common femoral, and subclavian veins. The purpose of this article is to review the indications, contraindications, techniques, complications, and management of centrally placed venous catheters. However, there is broad consensus that today, in the modern era, the competency to establish and manage a central venous catheter is an indisputably essential skill set for clinicians involved in the care of critically ill patients. Some controversy persists about the merits of specific site selection (e.g., which vein) and the relative associated complication rates of CVCs placed in different central veins. A notable exception is the adjunct of ultrasound guidance, which has recently become the standard of care for CVCs placed in the internal jugular vein, owing to associated decreases in complications and an increase in first-pass success. ĭespite these advancements, the procedure has remained relatively unchanged since the advent of the (now universally employed) Seldinger technique in the 1960s.

Various access techniques and devices were developed for many indications, including total parenteral nutrition administration, dialysis, plasmapheresis, medication administration, and hemodynamic monitoring, and to facilitate further complex interventions such as transvenous pacemaker placement. Over the following decades, central venous access rapidly developed into an essential experimental instrument for studying cardiac physiology and an indispensable clinical tool in treating many disease processes. These devices and the techniques employed to place them are synonymous with 'central line' or 'central venous access.' The placement of a CVC was first described in 1929. A central venous catheter (CVC) is an indwelling device inserted into a large, central vein (most commonly the internal jugular, subclavian, or femoral) and advanced until the terminal lumen resides within the inferior vena cava, superior vena cava, or right atrium.

Triple lumen central line distal