see also: [[Central Venous Catheter]] See: [MAC and cordis lines](https://rk.md/2020/mac-cordis-sheath-introducer-whats-the-difference/) #incomplete - 9Fr large lumen (brown), 12 gauge line, introducer sheath you can put a CVC in - flow rate through the 12 gauge port ~11 L/h ; 29+ L/h via the 9Fr port - ==are NOT pressure rated for CT contrast== (risk of line fracture) - can place pressure-rated CVC in sheath to give contrast, put through a peripheral line, or in an emergency, through the brown 9 french lumen at discretion of senior emergency doctor ![[Pasted image 20250227114925.png]] ## subclavian procedure ![[Pasted image 20250223173335.png]] - Infraclavicular approach: 1-2 cm inferior and lateral to the junction of the Medial 1/3 and the lateral 2/3’s of the clavicle. - Alternative insertion point is 1-2cm inferior and lateral to the centre of the clavicle, in the depression between deltoid and pec major - Orientate the needle so the bevel points infero-medially - Aim the needle for just above and posterior to the index finger - Angle of approach should be flat, with the needle passing just underneath the clavicle - Expect flashback at 3-4cm depth - Seldinger technique feed the guidewire through the needle - it should advance easily and position can be confirmed with US. (Avoid air embolism by placing finger over needle if there is a delay in feeding the wire) - Make a cut in the skin on wire with scalpel, or use 3-4 needle punctures (Avoid nicking the guidewire) - Insert the dilator to the hilt and dilate the track with a twisting motion - Feed the catheter over the guidewire - 16-18cm depth in the average person Secure the catheter with the clip and suture to skin in 2 places (at the skin and at the proximal end of the catheter)