Central Venous Catheters
Indications for placement of a central venous catheter include vasopressor requirement, centrally administered medications or nutrition, hemodynamic monitoring, placement of a pulmonary artery catheter, or intravenous access in critically ill patients. Informed consent should be obtained as there are several well-described risks. The procedure should be performed under full sterile precautions whenever possible, and catheters placed under suboptimal sterility should be removed or replaced within 24 h. Central venous catheters can be placed into the internal jugular vein, the subclavian vein, or the femoral vein. Ultrasound guidance should be considered standard of care for internal jugular access and is recommended for femoral access when non-emergent.