Central venous catheterization: Difference between revisions
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*Peripherally Inserted Central Catheter (PICC) | *Peripherally Inserted Central Catheter (PICC) | ||
Revision as of 03:16, 23 January 2021
Background
Types
- Central line: internal jugular
- Central line: subclavian
- Central line: supraclavicular
- Central line: femoral
- Pediatric central line
- Sheath introducer
- Peripherally Inserted Central Catheter (PICC)
Depths
- All +/- 2 cm
- Right IJ - 13 cm
- Right subclavian - 15 cm
- Left IJ - 15 cm
- Left subclavian - 17 cm
Indications
- Central venous pressure monitoring
- Administration of multiple medications and drips
- High volume/flow resuscitation[citation needed]
- Emergency venous access
- Inability to obtain peripheral venous access
- Repetitive blood sampling
- Administering hyperalimentation, vasopressors, caustic agents, or other concentrated fluids
- Insertion of transvenous cardiac pacemakers
- Hemodialysis or plasmapheresis
- Insertion of pulmonary artery catheters
Contraindications
Absolute[1]
- Infection over the placement site
- Anatomic obstruction (thrombosis of target vein, other anatomic variance)
- Site-specific
- Subclavian - trauma/fracture to ipsilateral clavicle or proximal ribs
Relative
- Coagulopathy (see below)
- Distortion of landmarks by trauma or congenital anomalies
- Prior vessel injury or procedures
- Morbid obesity
- Uncooperative/combative patient
Central line if coagulopathic
- Preferentially use a compressible site such as the femoral location (avoid the IJ and subclavian if possible, though IJ preferred over subclavian)
- No benefit to giving FFP unless artery is punctured[2]
- However, consider giving FFP if patient has hemophilia[3]
Flow Rates
Flow rate depends on diameter and length of IV; the Hagen–Poiseuille equation.[4]
PIV
- 16G IV: 13.2 L/hr
- 18G IV: 6.0 L/hr
- 20G IV: 3.6 L/hr
Central Line
- 5 Fr PICC/Port: 1.75 L/hr
- 7 Fr TLC 16G distal port: 1.9 L/hr
- 7 Fr TLC 18G proximal port: 3.4 L/hr
- 12 Fr HD: 23.7 L/hr
- 8.5 Fr Cordis/introducer sheath: 7.6 L/hr
- 8.5 Fr Cordis/introducer sheath with pressure bag: 20.0 L/hr
Complications
Complications vary by site
- Pneumothorax (more common with subclavian)
- Arterial puncture (more common with femoral)
- Catheter malposition
- Subcutaneous hematoma
- Hemothorax
- Catheter related infection (historically more with femoral)
- Catheter induced thrombosis
- Arrhythmia (usually from guidewire insertion)
- Venous air embolism (avoid with Trendelenburg position)
- Bleeding
Removal
See Also
- Central Line Placement Videos from EMCRIT
- Central Line Micro Skills from EMCRIT
- Critical care quick reference
- Access options
- 3SITES Trial
Vascular access types
- Central venous catheterization
- Rapid infusion catheter
- Intraosseous access
- Venous cutdown
- Umbilical vein catheterization
- Ultrasound assisted peripheral line placement
- External jugular vein cannulation
- The "Easy IJ"
- Midlines
References
- ↑ Graham, A.S., et al. Central Venous Catheterization. N Engl J Med 2007;356:e21
- ↑ Fisher NC, Mutimer DJ. Central venous cannulation in patients with liver disease and coagulopathy—a prospective audit. Intens Care Med 1999; 25:5
- ↑ Morado M.et al. Complications of central venous catheters in patients with haemophilia and inhibitors. Haemophilia 2001; 7:551–556
- ↑ Vascular Access. In: Marino, P. The ICU Book. 4th, North American Edition. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013:3-41