From the Guidelines
Central venous access via central line is indicated in several clinical scenarios where peripheral access is inadequate or contraindicated, including administration of vasopressors, irritant medications, and hypertonic solutions, as well as hemodynamic monitoring and long-term intravenous therapy. The decision to use central venous access should be based on the individual patient's needs and medical history, taking into account the potential risks and benefits of the procedure. Some of the key indications for central venous access include:
- Administration of vasopressors, irritant medications (such as chemotherapy, total parenteral nutrition, or solutions with pH <5 or >9), and hypertonic solutions (>10% dextrose or >5% protein) 1
- Hemodynamic monitoring, including central venous pressure measurement, frequent blood sampling, and emergency access when peripheral access cannot be established 1
- Long-term intravenous therapy, including antibiotics, parenteral feeding, and blood products 1
- Hemodialysis or plasmapheresis 1
- Poor peripheral venous access due to obesity, edema, or history of intravenous drug use 1 The choice of central venous access device and insertion site should be based on the patient's individual needs and medical history, as well as the potential risks and benefits of the procedure. Some of the key considerations for central venous access device selection include:
- Type of device: non-tunneled central venous catheters, tunneled central catheters, peripherally inserted central catheters (PICCs), and totally implantable devices 1
- Insertion site: internal jugular, external jugular, subclavian, and femoral veins 1
- Catheter tip position: the ideal position is between the lower third of the superior cava vein and the upper third of the right atrium 1 The use of ultrasound-guided venepuncture and maximal barrier precautions during insertion can help reduce the risk of complications, including infection and thrombosis 1. Regular flushing and locking of the catheter, as well as proper dressing and care of the exit site, can also help prevent complications 1. Overall, central venous access via central line can be a valuable tool in the management of patients with complex medical needs, but it should be used judiciously and with careful consideration of the potential risks and benefits.
From the Research
Indications for Central Access via Central Line
The indications for central access via central line include:
- Administration of long-term intravenous medications 2, 3, 4
- Blood product support 2, 3
- Total parenteral nutrition 2, 3, 5, 4
- Chemotherapy 3, 5, 4, 6
- Frequent blood draws 5, 4
- Long-term antibiotic treatment 5, 4
Patient Populations
Central access via central line is commonly used in various patient populations, including:
- Patients with cancer 3, 6
- Patients requiring long-term access who repeatedly experience catheter-related bloodstream infections despite stringent catheter care 2
- Patients with chronic kidney disease 5
- Critically ill pediatric and adult patients 4
- Patients receiving long-term chemotherapy 6
Types of Central Venous Access Devices
Different types of central venous access devices are used, including: