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Indications for and complications of central venous catheters

INTRODUCTION

Insertion of a central venous catheter (CVC) in a human was first reported by Werner Forssman, a surgical intern, who described canalizing his own right atrium via the cephalic vein in 1929. A technique that facilitates catheter placement into lumens and body cavities was subsequently introduced by Sven-Ivar Seldinger in 1953 [1]. Insertion of a CVC using the Seldinger technique has revolutionized medicine by allowing the central venous system to be accessed safely and easily [2].

CVCs are now common among critically ill patients. More than five million central lines are inserted each year in the United States alone [3]. Multi-lumen central venous catheters have become ubiquitous in the intensive care unit (ICU). New catheter designs and standardization of insertion techniques have reduced complication rates.

Indications, strategies to prevent complications, mechanical complications, and catheter removal are discussed here. The placement of CVCs and CVC-related infectious and thrombotic complications are discussed separately. (See "Placement of central venous catheters" and "Diagnosis of intravascular catheter-related infections" and "Prevention of intravascular catheter-related infections" and "Pathogenesis of and risk factors for central venous catheter-related infections" and "Catheter-induced upper extremity venous thrombosis".)

INDICATIONS

Common indications for placement of a CVC include:

  • Hemodynamic monitoring — A CVC permits measurement of the central venous pressure and the venous oxyhemoglobin saturation. In addition, it provides a conduit for insertion of a pulmonary artery catheter. (See "Insertion of Swan-Ganz catheters".)
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