From the Guidelines
Central lines are indicated for patients requiring reliable, long-term venous access for medical treatments, including administration of chemotherapy, total parenteral nutrition, or other irritating medications that can damage peripheral veins. The decision to insert a central line should be based on the patient's individual needs and medical history, taking into account the potential benefits and risks of the procedure 1.
Indications for Central Line Insertion
- Administration of vasopressors, chemotherapy, total parenteral nutrition, or other irritating medications that can damage peripheral veins
- Hemodynamic monitoring, frequent blood sampling, hemodialysis, or when peripheral access is difficult or impossible due to conditions like obesity, burns, or vascular disease
- Emergency situations requiring rapid fluid resuscitation or when multiple medications need simultaneous administration
Types of Central Venous Access Devices
- Non-tunnelled catheters: indicated for short-term use when peripheral venous access is unachievable
- Tunnelled central catheters: used when long-term access (>30 days) is required for the administration of chemotherapy, antibiotics, parenteral feeding and blood products
- Fully implantable or surgically implantable catheters (ports or port-a-caths): also provided for long-term use and associated with a low risk of infection
- PICCs: placed via a peripheral vein of the arm into the superior vena cava (SVC), with a main limitation of shorter longevity due to a higher risk of thrombosis 1
Considerations for Central Line Insertion
- Careful preoperative assessment, including the patient’s medical history, a physical examination, and the appropriate laboratory and radiological tests 1
- Insertion of an implantable venous access device should be carried out under strict sterile conditions, in the operating room, and under local anaesthesia, with or without sedation 1
- Antimicrobial prophylaxis to prevent catheter colonisation is not recommended 1
- Catheter tip position should be verified radiologically with an intraoperative fluoroscopy, or a post-operative chest X-ray 1
From the Research
Indications for Central Line Insertion
- Central line insertion is indicated for various medical conditions, including the need for parenteral nutrition, long-term intravenous antibiotics, and frequent blood draws 2.
- The choice of central line insertion depends on patient therapeutic needs, rather than fear of complications 3.
- Peripherally inserted central catheters (PICCs) are commonly used for central line insertion due to their low risk of complications, such as deep vein thrombosis and central line-associated bloodstream infections 3, 4.
Benefits and Risks of Central Line Insertion
- PICCs have numerous benefits, including low risk of central line-associated bloodstream infections and deep vein thrombosis 3.
- However, PICCs can be associated with local complications, such as leaking catheters, phlebitis, and malposition 4.
- Centrally inserted central catheters (CICCs) are also associated with risks, including deep vein thrombosis and central line-associated bloodstream infections 3.
Best Practices for Central Line Insertion and Care
- Adhering to best practices, such as using ultrasound and fluoroscopic guidance, can minimize the risk of complications associated with central line insertion 2.
- Proper care and maintenance of central lines, including hand hygiene, dressing management, and bathing practices, can significantly reduce the risk of central line-associated bloodstream infections 5.
- Nurses play a crucial role in ensuring proper maintenance and care of central lines, and familiarity with best practice interventions can help protect patients and prevent harm 5.