Indications for CVC
Apr 29, 2024![](https://kajabi-storefronts-production.kajabi-cdn.com/kajabi-storefronts-production/file-uploads/blogs/2147545446/images/4c21680-637-faf3-b84-14c7f841c72_5-5.png)
Who needs a central venous catheter (CVC)? To answer this question, we first need to outline what a CVC allows you to do. 🤷♀️🤷♂️
A CVC provides you with: 👇🏽👇🏽
👉🏻 Direct access to a central vein
👉🏻 Ability to give drugs/fluids that would normally damage peripheral veins
👉🏻 Secure, longer term venous access than a regular venous cannula
👉🏻 Ability to pace the heart
👉🏻 Ability to measure central venous or pulmonary pressures
👉🏻 Ability to provide fluid resuscitation*
*Note: A CVC is NOT a good large volume resuscitation line. Flow rates are 4X faster using a standard cannula of the same gauge. In patients needing rapid fluid resuscitation, your team should consider at least one 14g or 16g cannula. 🚨🚨
WIth that in mind, the indications for CVC can be summarised using the “DAMP” framework:
D - Drug indications
👉🏻 Inotropes (eg noradrenaline)
👉🏻 Potassium
👉🏻 Total parenteral nutrition (TPN)
👉🏻 Antibiotics (long term)
A - Access indications
👉🏻 Poor peripheral access
👉🏻 Likely difficult venepuncture in postoperative period
👉🏻 Poor access to arms (burns, upper limb surgery etc)
👉🏻 Likely need for multiple infusions in postoperative period
M - Monitoring indications
👉🏻 In patients where either central venous pressure monitoring or cardiac output monitoring is required
🔺 Cardiac surgery, liver surgery
🔺 Note: central venous pressure alone for guiding fluid management is not recommended
P - Pacing
👉🏻 In patients where transvenous pacing is required (eg transcatheter aortic valve implantation).
Contraindications to CVC insertion include:
👉🏻 Absolute
🔺 Active skin infection (locally)
🔺 Anatomical deformity at site
🔺 Implanted devices at site
🔺 Traumatic injury involving intended site
👉🏻 Relative
🔺 Coagulopathy
🔺 Uncooperative, awake patient
🔺 Landmark distortion
🔺 Morbid obesity
Just remember, CVC insertion is not without risk. Don’t be afraid to clarify the indication! ✅😀
Build knowledge ✅
Improve safety ✅
Note: this article does not cover central venous access for dialysis indications.
Ref:
https://www.ncbi.nlm.nih.gov/books/NBK557798/