A Tale of Marriage, Medicine and Murder

What does 'Subclavian IV Catheter' mean?

Find out what Subclavian IV Catheter means. Subclavian IV Catheter is explained by Margaret McMillion - author of PERSONAL BAGGAGE

Subclavian IV Catheter

A subclavian catheter, inserted beneath the clavicle (the bone connecting the sternum and the scapula, known as the collar bone), is indicated for emergency venous access when no peripheral IV site can be obtained. A subclavian has many benefits. It can be used for rapid administration of IV fluids and combinations of drugs, to obtain blood for tests, to give IV nutrition and, because it is inserted through the subclavian vein into the superior vena cava (the large vein that empties into the right atrium of the heart), it gives access to the central circulation and can be used for pacemaker insertion and to directly obtain measurements of pressures in the chambers of the heart. Other benefits of this site include consistent landmarks for insertion, increased comfort and security, and lower potential for infection compared to other sites of insertion, but the benefits must outweigh the many risks of complications, which include heart rhythm irregularities, puncture and collapse of a lung, arterial puncture, puncture of the heart, and air embolus.

Chest wall deformity is one contraindication and there are others, but the physician’s experience and comfort level with the procedure are the main determinants as to the success of line placement in cases with no other patient-related factors that may increase the incidence of complications.

The nurse’s job is to position the patient in Trendelenburg (on his back with the head of the bed lowered to prevent the catheter from sucking air) and to have the consent document ready for the patient to sign after the MD explains the procedure, and to provide the subclavian catheter kit to the doctor and have IV fluid ready to connect.

The physician explains the procedure, locates the landmarks, dons sterile garb, drapes the patient with the insertion site exposed, scrubs and deadens the site, then inserts the catheter according to proper procedure. Line placement must be verified by a chest X-ray. The nurse may dress the site and anchor the catheter.

On page 23 in PERSONAL BAGGAGE Penny recalls an attempted subclavian insertion procedure in which the patient died.

Search result for 'subclavian' in PERSONAL BAGGAGE

Chapter 3: Chapter Three
"...It had only been a month since Dr. Scales, with Penny assisting, stuck an actively-bleeding GI patient twenty-seven times trying to get a subclavian IV established when the nurses had been unable to start a peripheral IV. Scales used all four subclavian kits they stocked in the Unit, and there was blood everywhere when Penny called the supervisor for more. The supervisor brought what ER had, plus all the kits she ..."
" on the wallpaper as Dr. William Ghent, current Director of Critical Care, meandered in from the hall. He gave a nearly invisible nod to Dr. Scales. The two men had no affection for each other because Dr. Ghent had been Chief of Staff during the subclavian controversy, and he had pushed to have Dr. Scales’s hospital privileges revoked. ..."

Chapter 11: Chapter Eleven
"... I think he likes to help people. He’s had a hard life–-struggled and sacrificed to get himself through school.” “Did you hear about his problem with a subclavian?” “I heard him complain about having to get re-certified, but I don’t know what happened.” “Well, he was trying ..."
"...“Well, he was trying to insert the long needle under a very sick patient’s collarbone to reach the subclavian blood vessel because his peripheral IV had infiltrated. The old man’s blood pressure was dropping, and a subclavian would have given us good IV access and helped us monitor his fluid balance because it connects to the central circulation. Dr. Scales just wouldn’t give up: he stuck ..."

Chapter 19: Chapter Nineteen
"...Maureen’s veins were in such bad shape that a single subclavian was her only IV access and, unless they were compatible, only one solution could be infused at a time. The day-shift nurse reported that after infusing two units of blood, she had started Maureen on a combination of Benadryl, Ativan, and Decadron, a BAD drip, used to relieve ..."

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Subclavian IV Catheter

"Margaret McMillion’s novel intricately weaves a woman’s personal doubts and life trials into the intense and stressful operations..."

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