List some of the indications for a central venous cannula

• Measurement of right-heart filling pressure to guide fluid balance

• Administration of parenteral nutrition

• Administration of drugs that should be administered via a central vein (e.g. inotropes)

• Access for introduction of pulmonary artery catheter, pacing wires, etc.

• Establishing intravenous access if peripheral access is not possible

What different routes can be chosen for central vein access?

• Internal jugular vein

• Subclavian vein (this can be infra or supracalvicular)

• Femoral vein

• Peripheral veins (PICC lines)

Describe the course and relationships of the subclavian vein

The axillary vein becomes the subclavian vein at the level of the outer border of the first rib. It then proceeds medially, superior to the first rib and anterior to the scalenus anterior muscle. It remains behinds the clavicle and in close proximity to the dome of the pleura.

Describe the course and the relationships of the internal jugular vein

The internal jugular vein exits the base of the skull through the jugular foramen that corresponds to a point approximately one fingers breadth behind the lobe of the ear. It descends vertically and in its lower third lies behind the sternocleidomastoid muscle. It terminates at the medial end of the clavicle. This vein lies within the carotid sheath and in close proximity to the common carotid artery and the vagus nerve. The lower end of the internal jugular lies at the space between the sternal and clavicular heads of the sternocleidomastoid.