From the Research
Placing an Intravenous Central Catheter (IVC) in an arm that was recently in a cast is not recommended as a first option due to the increased risk of complications such as venous stasis, inflammation, or thrombosis. The recent immobilization from a cast can lead to changes in the affected limb, making catheter placement more challenging and risky. Before attempting placement, a thorough vascular assessment should be performed, including ultrasound evaluation to check for vessel patency and any clot formation, as suggested by studies on intravenous catheter complications 1. If possible, consider using the unaffected arm or alternative sites such as the jugular or subclavian veins for central access. The decision should be made on a case-by-case basis, weighing the urgency of central access against potential complications, and considering factors such as how recently the cast was removed, the condition of the veins, signs of inflammation or edema, and the patient's overall clinical status. Some studies suggest that the use of ultrasound guidance for peripheral intravenous catheters can decrease the need for central venous catheter placement 2, which may be beneficial in reducing complications. However, the most recent and highest quality study on the topic of intravenous catheter placement does not directly address the issue of recent cast immobilization, but emphasizes the importance of careful assessment and consideration of alternative sites 3. If placement in the previously casted arm is unavoidable, ultrasound guidance is essential to visualize the vessels properly and minimize complications. Key factors to consider in the decision-making process include:
- The time elapsed since the cast was removed
- The condition of the veins in the affected arm
- Signs of inflammation or edema
- The patient's overall clinical status and need for central access
- The potential benefits and risks of using alternative sites for central access. Given the potential risks and the availability of alternative options, it is generally recommended to avoid placing an IVC in an arm that was recently in a cast, unless absolutely necessary and with careful consideration of the potential complications, as supported by the principles outlined in studies on vascular access and catheter placement 4, 5.