Providing Central Venous Access — The Anterior Approach: Slideshow

In many situations, a semipermanent tunneled central line, as shown in this example, is preferred.

An anterior approach to the internal jugular vein is the best option in this situation because it offers the easiest route and a low risk for complications.

To start, the patient's head should be down and turned to the opposite side with a roll under the neck.

The patient should be draped for correct exposure.

The Seldinger technique is used here for internal jugular vein puncture.

The guidewire is passed through.

Next, a dilator peel-off sheath is threaded over the guidewire.

The central line is then tunneled in.

Here, the line length is being adjusted. The line should be handled with vascular forceps only (no-touch technique).

The line is then inserted into the peel-off sheath.

The radiograph shows the final position of the line in the right atrium.

The line is then fixated with suture.

A Mepore dressing is applied. It is an air-permeable, self-adhesive dressing that conforms to awkward areas and is good for low- to moderately exuding wounds.

For more information, see the following resources:

• eMedicine: Central Venous Access, Internal Jugular Vein, Anterior Approach, Tunneled
• eMedicine: Central Venous Access, Femoral Vein
• eMedicine: Central Venous Access, Internal Jugular Vein, Posterior Approach
• eMedicine: Central Venous Access, Subclavian Vein, Subclavian Approach
• eMedicine: Central Venous Access, Subclavian Vein, Supraclavicular Approach

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Author Information

Krishna Kumar Govindarajan, MCh, FEBPS, MRCS Ed, DNB, MS, MBBS
Specialist Registrar, Department of Pediatric Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
Disclosure: Krishna Kumar Govindarajan, MCh, FEBPS, MRCS Ed, DNB, MS, MBBS, has disclosed no relevant financial relationships.