Central Line Placement: Never Neglect the Basics
Hassan M. Ahmad MD
Intravenous (IV) access is a crucial part of anesthesia care, and placement and management of lines are important skills for both the anesthetist and anesthesiologist. Virtually all anesthetics require some degree of IV access, whether it is for induction of general anesthesia, administration of medications, fluid resuscitation, or blood sampling.
Before attempting to place a central line, be sure you are well versed on anatomic landmarks and appropriate techniques. This is never a benign procedure, so always make sure to weigh the risks and benefits and discuss them with the patient as part of your informed-consent process. Central line placement has been associated with several complications, including:
Accidental arterial puncture with pseudoaneurysm or hematoma
Pneumo- or hemothorax
Venous air embolism
Infection and sepsis
Cardiac arrhythmias
The decision to place a central line is multifactorial. Always assess the overall clinical picture, and discuss with the surgeon and intensive care unit (ICU) staff if possible. Some of the indications for obtaining central venous access are
Inability to obtain peripheral venous access.
Cardiac arrest or “code” situation. In this case, a femoral approach is best, as it does not interfere with chest compressions or endotracheal intubation.
Administration of certain medications. Generally, any medication that can cause direct damage to peripheral veins must be given centrally, for example, 3% saline. Also, highly concentrated vasopressors can cause vasospasm if given through a peripheral vein. Check with the pharmacy for other medications that need to be given centrally.Related posts:
Never Neglect the Basics of Airway Management
Consider the Use of Lidocaine in the Cuff of the Endotracheal Tube, But Be Aware of the Risks and Alternatives
Do Not Underestimate the Difficulty of Reintubating a Patient Who Has Undergone Carotid Endarterectomy or Cervical Spine Surgery
Do Not Use the Subclavian Vein for Central Access of Any Type in a Patient Planned for Dialysis
Consider the Use of Tris-Hydroxymethyl Aminomethane (THAM) to Treat Refractory or Life-Threatening Metabolic Acidosis
Be Aware of the Drugs that Require Slow Intravenous Administration
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