Ver el código de «Central venous catheterization»

==Background==
*Central venous catheters (CVCs) are often required to establish venous access in critically ill patients in order to administer rapid [[fluid resuscitation]], [[blood products]], and [[vasopressors]].  
*The sites of insertion fall into three locations: 
**Internal jugular (IJ)
**Subclavian
***Although subclavian lines appear to have a lower infection rate, there is greater incidence of mechanical complications.<ref>[[EBQ:3SITES Trial|3SITES Trial]]</ref> 
**Femoral 
*The major [[CVC catheter problems|complications]] of concern include: 
**[[Catheter-related bloodstream infections]] (CRBI)
**[[DVT]]
**Mechanical complications (e.g. [[pneumothorax]] and [[arterial puncture]])

==Types==
*[[Central line: internal jugular]]
*[[Central line: subclavian]]
*[[Central line: supraclavicular]]
*[[Central line: femoral]]
*[[Pediatric central line]]
*[[Sheath introducer]]
*Peripherally Inserted Central Catheter (PICC)

==Depths==
*All +/- 2 cm
*Right IJ - 13 cm or height (cm)/10
*Right subclavian - 15 cm or height (cm)/10 - 2cm
*Left IJ - 15 cm or height (cm)/10 + 4cm
*Left subclavian - 17 cm or height (cm) + 2cm

{{Central line indications}}

{{Central line contraindications}}

==Flow Rates==
Flow rate depends on diameter and length of IV; the Hagen–Poiseuille equation.<ref>Vascular Access. In: Marino, P. The ICU Book. 4th, North American Edition. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013:3-41</ref>

===PIV===
*16G IV: 13.2 L/hr
*18G IV: 6.0 L/hr
*20G IV: 3.6 L/hr

===Central Line===
*5 Fr PICC/Port: 1.75 L/hr
*7 Fr TLC 16G distal port: 1.9 L/hr
*7 Fr TLC 18G proximal port: 3.4 L/hr
*12 Fr HD: 23.7 L/hr
*8.5 Fr [[Sheath introducer|Cordis/introducer sheath]]: 7.6 L/hr 
*8.5 Fr [[Sheath introducer|Cordis/introducer sheath]] with pressure bag: 20.0 L/hr

==[[CVC catheter problems|Complications]]==
''Complications vary by site''
*[[Pneumothorax]] (more common with subclavian)
*Arterial puncture (more common with femoral)
*Catheter malposition
*Subcutaneous hematoma
*[[Hemothorax]]
*Catheter related infection [[EBQ:3SITES Trial|(historically more with femoral)]]
*Catheter induced thrombosis
*[[Arrhythmia]] (usually from guidewire insertion)
*Venous air embolism (avoid with Trendelenburg position)
*[[Hemorrhagic shock|Bleeding]]

==Removal==
[[Central Line: Removal]]

==See Also==
*[[CVC catheter problems]]
*[https://emcrit.org/central-lines/ Central Line Placement Videos from EMCRIT]
*[https://emcrit.org/emcrit/microskills-dilation/ Central Line Micro Skills from EMCRIT]
*[[Critical care quick reference]]
*[[Access options]]
*[[EBQ:3SITES Trial|3SITES Trial]]

{{Vascular access types}}

==References==
<references/>

[[Category:Critical Care]]
[[Category:Procedures]]
[[Category:Vascular]]