A Central Venous catheter is inserted in which veins, EXCEPT?

Appeared in: AIIMS Delhi NO - 2018

Explanation

The question asks to identify the vein that is NOT a site for central venous catheter insertion.
A central venous catheter's tip must be in a large central vein like the superior vena cava, inferior vena cava, or right atrium.
The Saphenous vein is a large superficial vein located in the leg.
It is part of the peripheral venous system and does not lead directly to the central circulation, making it unsuitable for CVC placement.

Option A: The left subclavian vein is a common and appropriate site for CVC insertion.
Option B: The right internal jugular vein is a very common and preferred site for CVC insertion.
Option C: The right femoral vein is a valid site for CVC insertion, especially in emergencies.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Central Venous Catheter (CVC) Insertion Sites as background academic context rather than a clinical decision trigger.
Site selection for CVCs is critical. The subclavian and jugular sites are generally preferred over the femoral site for non-emergency, long-term use due to a lower risk of catheter-related bloodstream infections.
After insertion into the subclavian or jugular vein, a chest X-ray is mandatory to confirm the catheter tip is correctly placed in the superior vena cava and to rule out complications like pneumothorax (collapsed lung).
What if the patient has severe burns on their chest and neck? In this scenario, the femoral vein would become the preferred site for central access, despite its higher infection risk, because the other primary sites are compromised.

How to Approach the Question

First, identify the negative keyword 'EXCEPT'. This signals that three of the options are correct CVC sites, and one is incorrect.
Recall the purpose of a 'Central' Venous Catheter: the tip must reside in a large, central vein close to the heart.
Evaluate each option based on its anatomical location.
The subclavian (in the chest), jugular (in the neck), and femoral (in the groin) veins are all large, central vessels that lead directly to the vena cava.
The saphenous vein is located in the leg and is a superficial, peripheral vein.
Conclude that the saphenous vein is the only option that is not a central vein, making it the correct answer to the 'EXCEPT' question.

Concept Tested & Keywords

Concept Tested: Central Venous Catheter (CVC) Insertion Sites
Stem keywords: Central Venous catheter, inserted, veins
Lead-in keywords: EXCEPT
Negative lead-in flag: The question asks for the exception, meaning the site that is NOT used.

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Practise the full AIIMS Delhi NO - 2018

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