B-30: Venography, Axillosubclavian / CVC

• Indications
  • Arm and/or shoulder swelling with or without a central venous catheter
  • Central venous catheter malfunction or pain on infusion
• Contraindications
  • Contrast allergy (premedicate or use CO₂)
• Patient Evaluation
  • Ability to lie supine, hold breath, and cooperate during procedure
• Preprocedure Orders
  • Routine
• Tools
  • 20-22ga. angiocaths
• Entry site
  • Peripheral (forearm or hand) vein - often bilateral access needed
• Technique
  • If a CVC is in place, aspirate and then inject each port gently using a 10cc or larger syringe with DSA filming over the entire catheter. Heparinize catheter ports when done. Catheter injections do not rule out pericatheter thrombosis. Perform venography through peripheral IV access using DSA. Begin with centering on the elbow and proceeding centrally. Bilateral injections are often necessary to completely opacify the SVC.
• Post-procedure Note
  • Routine
• Post-procedure Orders
  • Resume previous orders and medications

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