The preference for insertion site should be:
- First choice: right jugular vein ·
- Second choice: femoral vein
- Third choice: left jugular vein
- Last choice: subclavian vein with a preference for the dominant side
Internal Jugular
- Common technique that can allow good blood flows
- Right internal jugular lines are associated with the least recirculation and improved delivery of RRT compared with left
- Important structures nearby that are easily damaged
- Irritating to the awake patient
Femoral
- Easy placement by both landmark and ultrasound techniques
- Associated with least complications that are often the least life-threatening
- Blood flows compromised by patient positioning
- Should sit in the inferior vena cava, this often necessitates the use of a line of 20-24cm in length
- Associated with higher rates of CRBSI in earlier studies though not confirmed by recent meta-analysis
Subclavian
- Most comfortable for patient
- High-complication rate due to landmark technique and risk of pneumothorax
- Blood flows often compromised by changes in ventilation
- High incidence of subclavian vein stenosis following large bore dialysis catheters