Central Line Placement

Excerpt

A central venous line (CVL) is a large-bore central venous catheter placed using a sterile technique (unless an urgent clinical scenario prevents sterile technique placement) in specific clinical procedures. Sven-Ivar Seldinger, in 1953 introduced the method to facilitate catheter placement into the central veins lumens. Now referred to as the Seldinger technique, this procedure allows the safe and reliable insertion of a central venous catheter in the large lumen central veins. Central line placement is an essential skill, especially in critical care units. According to epidemiologic data, 8% of hospitalized patients require central venous access, and more than 5 million central venous catheters are inserted in the United States annually.

Over the past decade, there has been tremendous improvement and reduced complications associated with central line placement procedures. With ultrasound guidance, standardized techniques, new catheter designs, and central line care bundle, this procedure has become ubiquitous in the intensive care unit. This article will detail the anatomy of the site placement, indications and contraindications, equipment and personnel involved, technique, preparation, and associated complications.