Central Venous Catheterization

INDICATIONS:

• Large-volume parenteral fluid administration
• Monitoring of central venous pressure
• Emergency venous access
• Administration of some medications (e.g., chemotherapy)
• Administration of hyperosmolar solutions, such as some paraenteral nutrition formulas
• Placement of Swan-Ganz catheter
• Performance of hemodialysis or plasmapheresis

CONTRAINDICATIONS:

• Distortion of local anatomy or landmarks (may result from surgery, trauma, or irradiation to the area)
• For subclavian insertion, chest wall deformities (moderate to severe with distortion in local anatomy or landmarks)
• Suspected injury to the superior vena cava (e.g., superior vena cava syndrome in which venous access below the diaphragm is preferable)
• Bleeding diathesis or anticoagulation therapy
• Full-thickness burn, cellulitis, or other infection over the anticipated insertion site
• Pneumothorax or hemothorax on the contralateral side, or inability to tolerate Pneumothorax on ipsilateral side

PRE- and POST-PROCEDURE PATIENT EDUCATION:

Obtain informed consent for this procedure. Inform the patient of the possibilities of major complications and their management, which could require chest tube placement, surgery, or cardioversion. To minimize patient anxiety during the procedure, explain the major steps of the procedure and the necessity of remaining in the Trendelenburg position possibly for some time.

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