| Approach | Advantages | Disadvantages |
| External jugular | - Superficial vessel that is often visible
- Coagulopathy not prohibitive
- Minimal risk of pneumothorax (especially with US guidance)
- Head-of-table access
- Prominent in older adult patients
- Rapid venous access
| - Not ideal for prolonged venous access
- Poor landmarks in patients with obesity
- High rate of malposition
- Catheter may be difficult to thread
|
| Internal jugular | - Minimal risk of pneumothorax (especially with US guidance)
- Head-of-table access
- Procedure-related bleeding amenable to direct pressure
- Lower failure rate with novice operator
- 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 left
- Poor landmarks in patients with obesity/edematous patients
- Potential access and maintenance issues with concomitant tracheostomy
- Vein prone to collapse with hypovolemia
- Difficult access during emergencies when airway control being established
|
| Subclavian | - Easier to maintain dressings
- More comfortable for patient
- Better landmarks in patients with obesity
- Accessible when airway control is being established
- Associated with lower incidence of catheter-related infection*[1]
| - Increased risk of pneumothorax
- Procedure-related bleeding less amenable to direct pressure
- Decreased success rate with inexperience
- Longer path from skin to vessel
- Catheter malposition more common (especially right SCV)
- Interference with chest compressions
- Risk for stenosis/occlusion, which impacts future hemodialysis arteriovenous access
|
| Femoral | - Rapid access with high success rate
- Does not interfere with CPR
- Does not interfere with intubation
- No risk of pneumothorax
- Trendelenburg position not necessary during insertion
| - Delayed circulation of drugs during CPR
- Prevents patient mobilization
- Difficult to keep site sterile
- Difficult for PA catheter insertion
- Increased risk of iliofemoral thrombosis
|
