Central Venous Catheterization: Concise Definitive Review

Robert W. Taylor, MD; Ashok V. Palagiri, MD

Disclosures

Crit Care Med. 2007;35(5):1390-1396. 

In This Article

Abstract and Introduction

Objective: To provide current information related to central venous catheterization.
Design: Review of literature relevant to central venous catheterization and its indications, insertion techniques, and prevention of complications.
Results: Central venous catheterization can be lifesaving but is associated with complication rates of approximately 15%. Operator experience, familiarity with the advantages and disadvantages of the various catheterization sites, and strict attention to detail during insertion help in reducing mechanical complications associated with catheterization. Strict aseptic technique and proper catheter maintenance decrease the frequency of catheter-related infections.
Conclusions: Appropriate catheter and site selection, sufficient operator experience, careful technique, and proper catheter maintenance with removal as soon as possible are associated with optimal outcome.

Most patients admitted to an intensive care unit undergo intravenous cannulation.[1] Peripheral venous cannulation usually is attempted first; peripheral veins are readily accessible. Also, large bore, relatively short catheters facilitate rapid fluid infusion, so they are commonly used during initial resuscitation efforts.[2,3] Central venous access is indicated when peripheral veins are inaccessible, for administration of potent vasoactive drugs such as norepinephrine or dopamine, when irritating or hypertonic solutions such as potassium chloride or parenteral alimentation are infused, when incompatible medications must be infused through a multilumen catheter, when acute or subacute hemodialysis or hemofiltration is needed, or for hemodynamic monitoring or transvenous cardiac pacing. Large bore central venous catheters also facilitate extremely rapid infusion of resuscitation fluid.[4] More than 5 million central venous catheterizations (CVCs) are performed each year in the United States.[5]

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