Central Line Placement and Management

Benefits and Indications

The American Society for Parenteral and Enteral Nutrition recommends central lines for reliable venous access for essential therapies, including delivery of medications, nutrition solutions, and blood products that are too concentrated or irritating for peripheral veins 1, 2
Central lines provide direct access to large central veins where high-flow blood rapidly dilutes infused solutions, allowing for the administration of critical medications and nutrition 1, 3
The use of central lines eliminates repeated needle sticks for patients requiring long-term intravenous therapy, reducing the risk of complications and improving patient comfort 1
Central lines are essential for parenteral nutrition when the gastrointestinal tract cannot be used, and allow for the administration of chemotherapy, long-term antibiotics, and other critical medications 1, 2, 6

The risk of catheter-related bloodstream infection is approximately 5 per 1000 catheter-days, and can be reduced through proper hand hygiene, chlorhexidine antiseptic use, and prompt removal when no longer needed 1, 3
The risk of thrombosis is approximately 3 per 1000 catheter-days, and can cause arm swelling, pain, and discoloration 7
Femoral vein access carries a 10 times higher thrombosis risk than subclavian access, and should be avoided when possible 5, 8

The use of ultrasound guidance during central line insertion can significantly reduce the risk of mechanical complications, including arterial puncture and pneumothorax 1, 2
Maximal barrier precautions during insertion, including the use of chlorhexidine antiseptic, can reduce the risk of infection 1, 3
Regular assessment for signs of infection, including redness, drainage, and fever, is crucial for early detection and management of complications 7
Proper flushing and locking protocols when the catheter is not in use can help prevent occlusion and infection 1, 6