The ultrasound-guided positioning of a CICC in emergency involves the puncture and cannulation of deep veins of the supra-clavicular area or the infra-clavicular area. In the supra-clavicular area, different veins are available: the internal jugular vein (preferably, visualization in short axis and 'in plane' puncture), the subclavian vein (visualization in long axis and 'in plane' puncture) or the brachio-cephalic vein (visualization in long axis and 'in plane' puncture). In the infra-clavicular area, the axillary vein is accessible (visualization in oblique/long axis and 'in plane' puncture - or visualization in short axis and puncture 'out of plane').
The choice of the vein is based on the RaCeVA (Rapid Central Vein Assessment), a rapid and systematic ultrasound examination of the main deep veins of the area above/below the clavicle, so as to identify the vein apparently easiest to puncture (and therefore safest for the patient). In the hypovolemic patient, the internal jugular and the axillary veins are often collapsed and more difficult to cannulate.
Most CICC are made of low-cost polyurethane and are designed to be inserted with a simple Seldinger technique. The number of lumens will be determined by clinical needs.
The emergency CICC should preferably be removed within 24-48 hours.