Central venous catheterization

Inability to achieve the clinical goal by peripheral intravenous catheterization

• Relatively fast flow rate is required

• Rapid, massive intravascular volume resuscitation

• 3.5-inch, 8.5F introducer catheter offers the fastest flow rate. However, a 2-inch, 16-gauge peripheral catheter has a faster flow rate than the longer 16-gauge, centrally inserted triple-lumen catheter.

• Peripheral venous access cannot be found

Cardiopulmonary resuscitation and shock states

• Peripheral catheters are often difficult to place in shock states

• Drug administration is often more effective by central infusion

Administration of agents irritating to peripheral veins

• Concentrated potassium and sodium chloride solutions

• Total parenteral nutrition solutions

• Chemotherapy agents

• Vasopressors and inotropes

Central venous pressure monitoring

Pulmonary artery pressure monitoring

Transvenous pacemaker insertion

Hemodialysis

Plasmapheresis

Venous access for frequent blood sampling or for measurements of central venous oxygen saturation (ScvO ₂ )

Inferior vena cava filter placement

Extracorporeal life support cannulation

No absolute contraindications if experienced or supervised operator unless skin infection located at planned insertion site(s)

Relative contraindications

• Severe coagulopathy (including thrombocytopenia): Consider a femoral vein central catheter or peripherally inserted central catheter (PICC)

• Local skin infection

• Ipsilateral arteriovenous fistula

• Ipsilateral venous thrombosis

• Inferior vena cava filter: Avoid passing the guide wire beyond 20 cm during central line insertion from the jugular site in order to prevent entanglement

Ultrasound with small linear array probe (5–15 MHz)

Sterile sheath, gel, and needle guide for ultrasound

Catheter size and length appropriate for the site, side and indication (e.g., 16 cm for right internal jugular and right subclavian, 20 cm for left internal jugular or subclavian, single lumen, multilumen, 8.5F introducer)

Insertion kit, including 10-mL syringes, needles, guide wire, suture material, and local anesthetic

Sterile saline flush solution

Sterile fenestrated barrier drape for head-to-toe patient coverage

Four sterile towels

2% Chlorhexidine gluconate sterile prep stick

Sterile gown and gloves for the operator and assistant(s)

Cap to cover hair and mask with a face shield or protective glasses for the operator and assistant(s)

Sterile central line dressing kit

Shoulder roll (for subclavian vein catheterization)