Contraindications to Central Line Placement

Absolute Contraindications

Infection at the insertion site increases risk of catheter-related bloodstream infections, according to the Infectious Diseases Society of America 1, 2
Distorted anatomy that prevents clear identification of anatomical landmarks is a contraindication, as stated by the American Society of Anesthesiologists 3, 4
Known venous thrombosis or stenosis at the proposed insertion site is a contraindication, as recommended by the American College of Clinical Nutrition 1, 2
Vascular injury at the proposed insertion site is a contraindication, according to the International Journal of Infectious Diseases 3, 6

Morbid obesity makes landmark identification difficult but can be overcome with ultrasound guidance, as stated by the American College of Radiology 4, 7
Severe respiratory distress increases risk of complications during subclavian approach, according to the American Thoracic Society 3, 2
Previous radiation to the insertion area is a relative contraindication, as recommended by the American College of Radiology 4, 6
Presence of tracheostomy for internal jugular approach is a relative contraindication, according to the American College of Clinical Nutrition 5, 6

Femoral site should be avoided in adult patients when possible due to higher risk of infection compared to other sites, as stated by the Infectious Diseases Society of America 4, 2
Femoral site should be avoided in adult patients when possible due to increased risk of venous thrombosis, according to the American College of Clinical Nutrition 2, 6
Subclavian site should be avoided in patients with advanced kidney disease or on hemodialysis, as recommended by the National Kidney Foundation 2, 6
Subclavian site should be avoided in patients with severe respiratory compromise, according to the American Thoracic Society 4

Inability to obtain informed consent is a contraindication, unless emergency situation, as stated by the American Society of Anesthesiologists 3, 4
Lack of skilled personnel or appropriate equipment is a contraindication, according to the International Journal of Infectious Diseases 3, 6

Use ultrasound guidance to reduce risk of arterial puncture and pneumothorax, as recommended by the American College of Radiology 4, 2
Select appropriate insertion site based on patient factors and intended duration of use, according to the Infectious Diseases Society of America 4, 2
Use maximal sterile barrier precautions during insertion, as stated by the American College of Clinical Nutrition 1, 2
Choose appropriate catheter type and size, as recommended by the American College of Clinical Nutrition 1, 5
Ensure proper training of personnel performing the procedure, according to the International Journal of Infectious Diseases 1, 6

Ignoring site-specific risks, as each approach has unique complications, according to the American College of Radiology 4, 2
Failing to use ultrasound guidance when available, as it significantly reduces mechanical complications, as stated by the American Society of Anesthesiologists 3
Overlooking patient-specific factors that may increase risk, according to the International Journal of Infectious Diseases 3, 6