From the Guidelines
Central venous catheters (CVCs) are indicated for clinical scenarios where peripheral venous access is inadequate or inappropriate, including administration of vasopressors, irritant medications, or vesicants, long-term intravenous therapy, parenteral nutrition delivery, and hemodynamic monitoring. These indications are based on the most recent and highest quality study available, which used a validated method to develop appropriate indications for CVC use across patient populations 1. The study found that CVCs were preferred over peripherally inserted central catheters (PICCs) in certain scenarios, such as in critically ill patients when 14 or fewer days of use were likely.
Some of the key indications for CVCs include:
- Administration of vasopressors, irritant medications, or vesicants that would damage peripheral veins
- Long-term intravenous therapy requiring reliable access
- Parenteral nutrition delivery
- Hemodynamic monitoring, including central venous pressure measurement
- Rapid fluid resuscitation in critically ill patients
- Hemodialysis or plasmapheresis access
- Situations where peripheral access is difficult or impossible due to obesity, edema, burns, or vascular pathology
The choice of CVC depends on the expected duration of use, patient factors, and specific clinical needs. CVCs provide higher flow rates and more reliable access to the central circulation, but carry risks including infection, thrombosis, pneumothorax, and arterial puncture, so their use should be carefully considered against these potential complications. According to the study, CVCs were rated as appropriate for use in patients with cancer for irritant or vesicant infusion, regardless of duration 1. Overall, the use of CVCs should be guided by careful consideration of the potential benefits and risks, and should be based on the most recent and highest quality evidence available.
From the Research
Indications for Central Venous Catheter (CVC)
The indications for a Central Venous Catheter (CVC) include:
- Administration of chemotherapy 2, 3
- Fluid therapy 2, 4
- Antibiotic therapy 2, 4
- Parenteral nutrition 2, 3, 4
- Hemodynamic monitoring 5
- Procedures of dialysis/apheresis 5
- Long-term sequential chemotherapy, which is an indisputable indication of an implantable port 3
- Long-term parenteral nutrition, which is an indication of a tunneled cuffed catheter 3
Patient Requirements
CVCs are considered for patients who require:
- Multiple transfusions 6
- Central venous access for various clinical settings (emergency, intensive care, surgery) 5
- Treatment of less than 6 months, where PICC-lines have obvious advantages in terms of discretion and comfort 3
Clinical Settings
CVCs are used in various clinical settings, including: