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
  • 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
  • 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