Central Line Insertion: indications and contraindications
INDICATIONS:
- Major operative procedures involving large fluid shifts and/or blood loss
- Intravascular volume assessment when urine output is not reliable orunavailable (e.g. renal failure)
- Major trauma
- Surgical procedures with a high risk of air embolism, such as sitting position craniotomies. In addition to monitoring, the central venous pressure (CVP) catheter may also be used to aspirate intracardiac air
- Frequent venous blood sampling
- Administration of medications that require central access e.g. amiodarone, inotropes, high concentration electrolytes
- Chronic drug administration
- Unavailable peripheral IV access
- Rapid infusion of IV fluids
- Peripheral blood stem cell collections
- Special Uses: (i) Insertion of PA catheters; (ii) Insertion of transvenous pacing wires; (iii) Hemodialysis/plasmapheresis.
CONTRAINDICATIONS:
- SVC syndrome
- Infection at the site of insertion
- Traumatised site (eg. clavicle fracture and subclavian line)
- Burned site
- Coagulopathies
- Newly inserted pacemaker wire
- Presence of carotid disease
- Recent cannulation of the internal jugular vein
- Contralateral diaphragmatic dysfunction
- Thyromegaly or prior neck surgery.
