Vascular-Access Anatomy — Central & Arterial

Also known as Vascular access anatomy · Central venous catheter · Internal jugular vein · Subclavian vein · Carotid sheath · Radial artery · Allen test · Femoral vein

Vascular-access anatomy for the ICU First Part: the central venous routes (internal jugular in the carotid sheath, subclavian below the clavicle, femoral in the femoral sheath) with their risks and the tip position at the cavoatrial junction, and the arterial-line sites (radial with the Allen test for ulnar collateral flow, femoral, dorsalis pedis).

high14 referencesUpdated 26 July 202633 min readVerification in progress

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8 MCQs

The one-paragraph exam answer

The three central routes each trade convenience against a distinctive danger. Internal jugular — in the carotid sheath (carotid medial and deep, vagus between, deep to SCM), approached at the apex of the two SCM heads under ultrasound; straight to the SVC on the right, compressible, low pneumothorax, but carotid puncture and (left side) thoracic-duct injury. Subclavian — below the clavicle between clavicle and first rib; lowest infection but the highest pneumothorax and not compressible (avoid in coagulopathy), and stenosis kills a future fistula. Femoral — in the femoral sheath, lateral-to-medial N-A-V; compressible and safe in arrest but the highest infection and DVT. The tip sits in the SVC above the cavoatrial junction — the carina on chest X-ray. Arterial: radial at the wrist (Allen test for ulnar collateral flow); alternatives femoral, dorsalis pedis.

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Meet the patient

A 68-year-old with urosepsis rolls into ICU at 2 am: INR 2.4, platelets 70, cool peripheries, lactate 4.2, needing noradrenaline through reliable central access now. The registrar reaches for the subclavian kit — the cleanest, lowest-infection line they know.^[1]

Before that needle moves, one decision decides the next complication: which vein, and can you compress it if it bleeds? In a coagulopathic patient who cannot afford a haemothorax, compressibility is not a footnote — it is the whole decision. Hold that question, and every site below sorts itself.^[1]^[3]

References14Show

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