CENTRAL LINE

Course overview

CENTRAL VENOUS CATHETERIZATION (CVC) IS A PROCEDURE FREQUENTLY REQUIRED IN ACUTE OR CRITICAL CARE RESUSCITATION. INDICATIONS INCLUDE PATIENTS WITH MULTIPLE, INCOMPATIBLE INTRAVENOUS (IV) MEDICATIONS WITH LIMITED PERIPHERAL ACCESS, OR WHO ARE BEING TREATED WITH VASOACTIVE OR PHLEBOSCLEROTIC AGENTS WHICH MAY NOT BE SUITABLY CARED FOR WITH A PERIPHERAL IV ALONE. SOME CENTRAL LINES ARE ALSO PLACED FOR TEMPORARY OR PERMANENT HEMODIALYSIS ACCESS; THESE DIALYSIS CATHETERS ARE SIGNIFICANTLY LARGER THAN TRADITIONAL DOUBLE, TRIPLE, OR QUADRUPLE LUMEN CATHETERS PLACED IN THE EMERGENCY DEPARTMENT OR INTENSIVE CARE UNIT SETTING. CENTRAL LINES MAY ALSO BE PLACED TO INTRODUCE SWAN GANZ CATHETERS TO MEASURE INTERNAL HEMODYNAMICS OF THE HEART, OR TO INTRODUCE TEMPORARY TRANSVENOUS PACEMAKER LEADS IN THE CRITICALLY ILL PATIENT WHO HAS SEVERE BRADYCARDIA OR HIGH-DEGREE HEART BLOCK; THESE ARE CALLED INTRODUCER CATHETERS. MOST CENTRAL LINES ARE PLACED TODAY VIA THE SELDINGER TECHNIQUE, WHICH IS SAFER THAN THE PREVIOUSLY USED "CUT-DOWN" TECHNIQUE. THIS ACTIVITY REVIEWS THE INDICATIONS, CONTRAINDICATIONS, AND TECHNIQUE INVOLVED IN PERFORMING CENTRAL LINE PLACEMENT AND HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL TEAM IN THE CARE OF PATIENTS UNDERGOING THIS PROCEDURE.