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

Catheter Selection

A large variety of central venous catheters are available for clinical use. They may have single or multiple lumens. The number of catheter lumens does not affect complication rate, so the number of lumens should be chosen to best meet clinical needs.[54,55,56,57] Multilumen catheters are commonly selected and often negate the need for multiple CVC sites. Triple-lumen and quadruple-lumen catheters are extremely useful in the day-to-day care of critically ill patients. However, because of relatively small individual-lumen diameter and long catheter length (>20-30 cm), resistance to flow is high, making these catheters less than ideal for rapid fluid infusion.

Larger, shorter catheters are more conducive to rapid fluid administration. An 8.5-Fr introducer sheath is commonly used for this purpose. The sheath is designed for introduction of longer devices such as the pulmonary artery catheter. Nonetheless, because of its relatively short length (<10 cm) and large lumen size, the sheath is commonly used to facilitate very rapid fluid infusion during resuscitation attempts.[3,4] Many introducer sheaths are relatively stiff and have been associated with perforation of the superior vena cava and innominate veins. Air embolization has been associated with this type of catheter due to malfunction of the catheter introducer valve and with disconnection of the catheter side port.[28,29] Prompt removal of the sheath introducer is recommended after initial fluid resuscitation has been completed or after a pulmonary artery catheter has been removed.

Dialysis catheters are typically double-lumen, large bore catheters because of the high flows required for dialysis. They are commonly used for acute dialysis and during the several-week period needed for an arteriovenous fistula to mature. Use of the internal jugular, subclavian, and femoral veins spares the vessels of the upper extremities for future vascular access.

Long-arm catheters (also called peripherally inserted central catheters), tunneled catheters (Hickman, Broviac, Groshong), and totally implantable central venous catheters also have a place in the care of the critically ill patient but are not discussed here in detail.[58,59,60]

Catheters impregnated with chlorhexidine and silver sulfadiazine and catheters impregnated with minocycline are associated with fewer catheter-related bloodstream infections than nonimpregnated catheters and should be considered in all cases.[50,61,62]

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