Central venous catheterization

Types

• Central line: internal jugular
• Central line: subclavian
• Central line: supraclavicular
• Central line: femoral
• Pediatric central line
• Peripherally Inserted Central Catheter (PICC)

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

• 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
  • However, consider giving FFP if patient has hemophilia

Flow Rates

PIV

• 16G IV: 220 ml/min
• 18G IV: 105 ml/min

Central Line

• Cordis/introducer sheath: 126 ml/min
• 16G distal port TLC: 69 ml/min
• PICC/Port: varies by gauge

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

See Also

• Critical care quick reference
• Access options