Central venous catheters. Kristin wise, md, fhm. Objectives. Understand the indications & contraindications for Central Venous Catheters (CVCs) Identify factors that influence the selection of appropriate site for CVC insertion Describe the procedural steps for CVC placement
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Central venous catheters
Kristin wise, md, fhm
No absolute contraindications for CVC placement
Important relative contraindications:
(ie, PTX in hypoxic pt)
Remember these complications to obtain informed consent
8.5-French common for introducers
11.5-French common for HD
<10cm for introducers
Lumens—single, double, triple, quadruple
AHRQ (2001)—Top 11 most highly-rated safety practices
“Use of real-time US guidance during CVC
insertion to prevent complications”
“Use of maximum sterile barriers while placing CVCs to prevent infections”
IJ vein Landmarks:
SC vein Landmarks:
(lidocaine causes vasospasm & systemic effects!)
Dr. Sven-Ivar Seldinger (1921-1998)
In 1953 to obtain safe
access to blood vessels
& hollow organs
Modified version in use today.
Cannulate vein with US guidance (preferred)
Use non-dominant hand (set aside US) to grasp needle
Disconnect syringe with dominant hand
Aspirate to ensure proper needle placement
Consider ↑ Trendelenburg
Rosen BT, Wittnebel K. Central line placement. In: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS, eds. Principles and Practice of Hospital Medicine. 1st ed. New York, NY: McGraw-Hill; 2012:860-65.
McGee DC, Gould MK. Preventing complications of central venous catheterization. NEJM. 2003;348(12):1123-33.
Taylor RW, Palagiri AV. Central venous catheterization. Crit Care Med. 2007;35(5):1390-96.
Heffner AC, Androes MP. (2013). Overview of central venous access. In: Collins KA, ed. UpToDate. Available from http://www.uptodateonline.com.
Web-based resources: Videos in Clinical Medicine
Graham AS, OzmentC, TegtmeyerK, Lai S, BranerDV. Central venous catherization. NEJM. 2007;356:e21.
Braner DAV, Lai S, EmanS, Tegtmeyer K. Central venous catherization—Subclavian vein. NEJM. 2007;357:e26.