Intravenous cardiac insertion includes that for central lines, central venous pressure monitors, and/or pulmonary artery catheters. Sites for insertion include:

1. Internal Jugular Approach - The right internal jugular vein is typically used because the approach has a shorter and straighter path to the heart than the left internal jugular vein approach.
2. Subclavian Approach - The left subclavian vein is typically used because it does not have as acute of an angle as the right subclavian vein to reach the superior vena cava.
3. External Jugular Approach - This site is occasionally chosen because the vessel is relatively easy to puncture, compress, and because it lacks an artery which follows a similar path. However, the presence of valves in this vein can make threading a catheter difficult.
4. Femoral Vein Approach - This site is rarely used because the vessel can be difficult to puncture and thread; fluoroscopic assistance is often necessary.

Although a physician always inserts a central line or pulmonary artery catheter (PAC), it is important to know the anatomy of the insertion sites and the potential complications of the procedures.

There are two vessels which are most commonly used for PAC or central line insertion:

1. Right Internal Jugular Vein - commonly chosen for its accessibility and relatively low complication risk. Carotid hematoma is a potentially major complication of this procedure.
   • Superficial Structures
     • Sternocleidomastoid muscle - covers the lower portion of the internal jugular vein and runs lateral to the upper portion.
     • Deep cervical lymph nodes - follow the internal jugular vein up through the neck.
   • Deep Structures
     • Phrenic Nerve
     • Vagus Nerve
     • Common Carotid Arteries
2. Subclavian Vein - often chosen when neck injury makes internal jugular insertion more difficult. The proximity of the subclavian vein to the lung increases the risk of hemothorax or pneumothorax with this approach
   • Superficial Structures
     • Clavicular head of pectoralis major
     • Subclavius
     • Clavicle
     • Thoracic duct - enters the subclavian vein near its junction with the internal jugular vein.
   • Deep Structures
     • Dome of the pleura
     • Axillary artery
     • Subclavian artery

• Internal Jugular Vein Insertion
  • Complication with inserting the catheter into the IJV?
• Internal Jugular Vein
• Subclavian Vein
• Brachiocephalic Vein
• Superior Vena Cava
• Right Atrium
• Right Ventricle
• Pulmonary Artery