advance 60 degrees to skin aiming towards ipsilateral nipple (blood should be obtained within 3cm).insert 1cm above the apex of head of sternocleidomastoid and clavicle.inferior petrosal sinus, facial, pharyngeal, lingual, superior thyroid, middle thyroid, occipital veins.posterior relations: transverse process of the cervical vertebrae, levator scapulae, scalenus medius and anterior, cervical plexus, phrenic nerve, thyrocervical trunk, vertebral vein, 1st part of subclavian artery.anterolateral relations: skin, superficial fascia, platysma, cervical fascia, sternomastoid, sternohyoid, omohyoid.medial relations: internal and common carotid arteries, 9th to 12th cranial nerves above common carotid artery and vagus.joins subclavian vein behind sternal extremity of clavicle.ensure control of the guidewire at all times.brown lumen is the distal lumen (used for CVP monitoring).raised intracranial pressure (ICP) (cannot tilt head down).overlying skin infection, burn or other disease processįemoral access can still be used in the following situations:.Large bore peripheral IV lines, RICC lines, Swan sheaths or IO access are preferred for rapid fluid resuscitation. Renal replacement therapy, plasmapheresis and apheresis (using a vascath).vasoactive agents, chemotherapy or parenteral nutrition administration) Infusions of irritant substances (e.g.Central venous oxygen saturation (ScvO2) monitoring/sampling.Central venous pressure (CVP) monitoring.Intravenous (IV) access (especially if difficult peripheral access).Central venous catheter (CVC) is a cannula placed in a central vein (e.g.
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