From the Guidelines
A central line is needed when a patient requires reliable, long-term venous access for medical treatments that cannot be safely or effectively delivered through peripheral veins, such as total parenteral nutrition, which requires central venous access to deliver high osmolarity solutions directly into the superior vena cava or the right atrium 1.
Key Indications for Central Lines
- Administering medications that are irritating to peripheral veins, such as chemotherapy drugs or vasopressors
- Delivering total parenteral nutrition, which requires central venous access to ensure safe and effective delivery of nutrients
- Providing frequent blood draws without repeated needle sticks
- Hemodynamic monitoring in critically ill patients
- Rapid infusion of large fluid volumes during resuscitation
- Hemodialysis or plasmapheresis
Types of Central Lines
- Peripherally inserted central catheters (PICCs)
- Tunneled catheters
- Implanted ports
- Non-tunneled central venous catheters
Considerations for Central Line Placement
- The choice of vein for central line placement is affected by several factors, including venepuncture technique, the risk of related mechanical complications, and the feasibility of appropriate nursing of the catheter site 1
- Ultrasound-guided venepuncture is strongly recommended for all central line insertions to reduce the risk of complications and improve the success rate of placement 1
- The position of the central line tip should be checked during the procedure, and postoperative X-ray is mandatory if the position of the tip has not been checked or if the device has been placed using a blind subclavian approach 1
Risks and Benefits of Central Lines
- Central lines offer significant benefits, including reliable access for medical treatments and reduced vein irritation
- However, they also carry risks, including infection, thrombosis, pneumothorax during insertion, and air embolism 1
- Therefore, central lines are typically reserved for situations where peripheral access is inadequate or inappropriate for the required treatment.
From the Research
Importance of Central Lines
- Central lines are necessary for patients who require prolonged intravenous therapy 2
- The goal of using central lines is to provide safe, effective, and reliable vascular access for infusion therapy 2
- Central lines are used to administer medications and fluids, and are essential in almost all areas of healthcare 2
Patient Assessment and Device Selection
- A detailed patient assessment is required before choosing a central venous access device 2
- The selection of a central line depends on various clinical indications and the range of long-term intravenous therapies that can be used 2
- Proper patient assessment can help reduce complications and facilitate earlier recognition of potential problems 2