Central venous catheter placement
Formal Definition
A bedside or operating-room procedure for placement of a central venous catheter (CVC) into a large central vein — typically the internal jugular (IJ), subclavian, or femoral vein — with the catheter advanced so the tip resides in the superior vena cava (SVC) near the right atrium; used for hemodynamic monitoring (central venous pressure, ScvO2), administration of vasopressors and irritating medications (chemotherapy, hypertonic solutions, amiodarone, calcium), hemodialysis access (large-bore dual-lumen or triple-lumen dialysis catheters), parenteral nutrition (TPN), and reliable long-term venous access when peripheral options are inadequate; requires strict sterile technique with full barrier precautions and ultrasound guidance to minimize infection and mechanical complications.
How It's Used on the Ward
"Central line" or "place a central line" or "CVC" — placing a catheter into a big vein (typically internal jugular or subclavian) into the central circulation; for patients on pressors, needing TPN, needing close volume monitoring, or who can't get peripheral IVs; sterile technique is mandatory, ultrasound guidance is standard, post-placement X-ray to confirm tip position before use.
Example
""Septic shock patient with peripheral IV access failing. Resident places right internal jugular triple-lumen central venous catheter using ultrasound guidance and full sterile technique, 12 mL of blood return from each port. Vasopressors immediately transitioned from peripheral to norepinephrine through the distal port. Sterile dressing applied. Post-procedure chest X-ray confirms catheter tip in the SVC, no pneumothorax. Strict central line bundle compliance: chlorhexidine dressing change q7 days, daily assessment of line necessity, scrubbing the hub before each access.""
Clinical Context
Indications: vasoactive medications (pressors benefit from central access due to extravasation risk into peripheral tissue), hypertonic solutions (TPN, hypertonic saline, calcium chloride), chemotherapy infusion, hemodialysis access, hemodynamic monitoring, inadequate peripheral access, anticipated prolonged IV therapy. Site selection: (1) IJ — preferred site clinically, ultrasound guidance available, lower pneumothorax risk than subclavian, but risk of carotid puncture. (2) Subclavian — lower infection rate than IJ, more comfortable for patient, but highest pneumothorax risk, not ideal for coagulopathy (no compressibility). (3) Femoral — last resort for emergent access, highest infection and DVT risk, but compressible in coagulopathy. Universal precautions: full barrier (cap, mask, sterile gown, sterile gloves, large sterile drape), chlorhexidine skin prep, ultrasound for IJ site, maximal barrier precautions for subclavian; CHG dressing, daily review of necessity. Post-placement: chest X-ray to confirm tip position (cavoatrial junction or upper SVC) and rule out pneumothorax before use. Bundle compliance (CLABSI prevention) drives quality metrics — central line-associated bloodstream infections tracked intensively.