Approach Advantages Disadvantages Internal Jugular Minimal risk of -Not ideal for prolonged pneumothorax (especially access with US guidance) -Risk of Carotid artery puncture Head of table access Uncomfortable -Dressings and catheter Procedure-related difficult to maintain bleeding amendable to -Thoracic duct injury direct pressure possible on the left -Poor landmarks in Lower failure rates with obese/edematous pts novice operators -Vein prone to collapse with hypovolemia Excellent target using US -Difficult to access during guidance emergencies when airway control is being established Subclavian Easier to maintain -Increased risk of dressing pneumothorax -Procedure related More comfort bleeding less amenable to direct pressure Better landmarks in obese -Decrease success with pts inexperienced operators -Longer path from skin to Accessible when airway is vessel being established -Catheter malposition more common -Interference with compressions Femoral Rapid access with high -Delayed circulation of success rates drugs during CPR -Prevents pt moving Does not interfere with -Difficult to keep site CPR sterile -Increased risk of Does not interfere with thrombosis intubation No risk of pneumothorax
Approach Advantages Disadvantages Internal Jugular Minimal risk of pneumothorax (especially with US guidance) Head of table access Procedure-related bleeding amendable to direct pressure Lower failure rates with novice operators Excellent target using US guidance -Not ideal for prolonged access -Risk of Carotid artery puncture Uncomfortable -Dressings and catheter difficult to maintain -Thoracic duct injury possible on the left -Poor landmarks in obese/edematous pts -Vein prone to collapse with hypovolemia -Difficult to access during emergencies when airway control is being established Subclavian Easier to maintain dressing More comfort Better landmarks in obese pts Accessible when airway is being established -Increased risk of pneumothorax -Procedure related bleeding less amenable to direct pressure -Decrease success with inexperienced operators -Longer path from skin to vessel -Catheter malposition more common -Interference with compressions Femoral Rapid access with high success rates Does not interfere with CPR Does not interfere with intubation No risk of pneumothorax -Delayed circulation of drugs during CPR -Prevents pt moving -Difficult to keep site sterile -Increased risk of thrombosis
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