From the Guidelines
The correct patient position for a central line insertion is the Trendelenburg position, where the patient lies flat on their back with their head tilted down at a 15-30 degree angle. This position helps distend the neck veins, particularly the internal jugular vein, making it easier to visualize and access 1. It also reduces the risk of air embolism by increasing venous pressure above atmospheric pressure. For subclavian approaches, a slight Trendelenburg position is still recommended, though some practitioners may place a rolled towel between the shoulder blades to improve access. The patient's head should be turned away from the insertion site for internal jugular access, while keeping the head in neutral position for subclavian approaches.
Proper positioning is essential for successful cannulation and reducing complications. The patient should remain in this position throughout the procedure until the line is secured and confirmed to be properly placed. If the patient cannot tolerate Trendelenburg positioning due to respiratory or other issues, alternative positions may be considered with extra precautions to prevent air embolism. The use of ultrasound guidance, as recommended by recent guidelines 1, can also help improve the safety and quality of central venous catheter placement.
Some key considerations for patient positioning include:
- The internal jugular vein route may have a lower risk of mechanical complications than the subclavian route 1
- The subclavian route may have a lower risk of catheter-related bloodstream infection 1
- The femoral vein route is relatively contraindicated due to a high risk of infection and catheter-related venous thrombosis 1
- The use of a rolled towel between the shoulder blades can improve access for subclavian approaches
- The patient's head should be turned away from the insertion site for internal jugular access, while keeping the head in neutral position for subclavian approaches.
Overall, the Trendelenburg position is the recommended position for central line insertion, as it helps to distend the neck veins and reduce the risk of air embolism. However, the specific approach and positioning may vary depending on the individual patient's needs and the practitioner's preference.