In the absence of the possibility of inserting a PICC at the arm or a CICC in an axillary vein, short-term central venous access in the hospitalized patient is obtained by inserting a CICC via an ultrasound-guided puncture and cannulation of a vein in the supra-clavicular area (internal jugular, brachio-cephalic, subclavian).
The catheter will be inserted in the best available central vein (the one whose puncture appears easiest, and therefore safest), choosing between brachio-cephalic vein, internal jugular vein, subclavian vein and external jugular vein. The insertion must be performed according to a standardized implantation protocol, such as for example the SICA protocol (Safe Insertion of Central Access) developed by GAVeCeLT, which includes (a) pre-procedural ultrasound evaluation of the veins (RaCeVA), (b) adoption of maximum barrier precautions and skin antisepsis with chlorhexidine 2% in alcohol, (c) ultrasound-guided venipuncture, (d) intra-procedural assessment of tip position by intracavitary ECG technique, and (e) sutureless securement in the supra-clavicular area.