In medicine, a central venous catheter ("central line", "CVC", "central venous line" or "central venous access catheter") is a catheter

placed into a large vein in the neck (internal jugular vein ), chest (subclavian vein or axillary vein) or groin (femoral vein). It is used to administer medication or fluids, obtain blood tests (specifically the "mixed venous oxygen saturation"), and directly obtain cardiovascular measurements such as the central venous pressure.

Indications and uses

Indications for the use of central lines include:[2]

Monitoring of the central venous pressure (CVP) in acutely ill patients to quantify fluid balance Long-term Intravenous antibiotics Long-term Parenteral nutrition especially in chronically ill patients Long-term pain medications Chemotherapy Drugs that are prone to cause phlebitis in peripheral veins (caustic), such as: o Calcium chloride o Chemotherapy o Hypertonic saline o Potassium chloride o Amiodarone o vasopressors (e.g. epinephrine, dopamine) Plasmapheresis Peripheral blood stem cell collections Dialysis Frequent blood draws Frequent or persistent requirement for intravenous access Need for intravenous therapy when peripheral venous access is impossible o Blood o Medication o Rehydration

Central venous catheters usually remain in place for a longer period of time than other venous access devices, especially when the reason for their use is longstanding (such as total parenteral nutrition in a chronically ill patient). For such indications, a Hickman line, a PICC line or a portacath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a porte d'entre (place of entry) for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci.[citation
needed]

[edit] Insertion

Triple lumen in jugular vein

Chest x-ray with catheter in the right subclavian vein The skin is cleaned, and local anesthetic applied if required. The location of the vein is then identified by landmarks or with the use of a small ultrasound device. A hollow needle is advanced through the skin until blood is aspirated; the color of the blood and the rate of its flow help distinguish it from arterial blood (suggesting that an artery has been accidentally punctured), although this method is inaccurate.[citation needed] Ultrasound probably now represents the gold standard for central venous access and skills, within North American and Europe, with landmark techniques are diminishing.[3][4] The line is then inserted using the Seldinger technique: a blunt guidewire is passed through the needle, then the needle is removed. A dilating device may be passed over the guidewire to slightly enlarge the tract. Finally, the central line itself is then passed over the guidewire, which is then removed. All the lumens of the line are aspirated (to ensure that they are all positioned inside the vein) and flushed.[citation needed] A chest X-ray is typically performed afterwards to confirm that the line is positioned inside the superior vena cava and, in the case of insertion through the subclavian vein, that no pneumothorax was caused as a side effect. Vascular positioning systems can also be used to verify tip placement during insertion without the need to a chest X-ray, but this technique is not yet a standard of practice. Videos are available demonstrating placement of a central venous catheter without [5] and with ultrasound guidance.[6]

Complications
Central line insertion may cause a number of complications. The benefit expected from their use therefore needs to outweigh the risk of those complications