HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

CENTRAL CATHETERS

Engin Haftacı

Kocaeli City Hospital, Department of Intensive Care, Kocaeli, Türkiye

Haftacı E. Central Catheters. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.291-304.

ABSTRACT

Central venous catheters are invasive procedures commonly employed for diagnostic and therapeutic purposes to critically ill patients who have inadequate peripheral venous access or who require longterm vascular access. Historically, central venous catheterization, which was first described by Aubaniac in 1952, has undergone significant advances with the application of the Seldinger Technique. The main indications for central venous catheterization include inadequate peripheral vascular access for fluid and drug administration, hypovolemia, peripheral circulatory disorders, shock, cardiopulmonary resuscitation requirements, and invasive diagnostic procedures. The Subclavian Vein (SV), Internal Jugular Vein (IJV), and Femoral Vein (FV) are the most commonly employed vascular access for catheter placement. The IJV is generally the first choice because of its low complication rate and the SV carries a lower risk of infection in long-term use. FV is suitable for short-term use but has limitations in long-term use because of the risk of infection. Complications of central venous catheterization are divided into 3 as infectious, mechanical, and thrombotic. Catheter-Related Infections usually develop through the skin entry site, catheter ports, or hematogenous spread. Antiseptic-coated catheters were found to be effective in reducing the risk of infection. Mechanical complications include arterial puncture, pneumothorax, venous air embolism, and arrhythmias. Pneumothorax, in particular, is more common with SV catheterization. Thrombotic complications usually appear with long-term catheter use. Ultrasonography (US) guided central venous catheterization allows rapid and reliable detection of anatomical variations and vascular pathologies. Short Axis (SA) and Long Axis (LA) approaches optimize the needle and vessel relationship in application, increasing the success rate and reducing the risk of complications. Routine use of US has increased success, especially in internal jugular vein and femoral vein catheterizations, and decreased complications e.g., arterial puncture. Strict adherence to aseptic techniques during central venous catheter placement is critical to prevent related complications. Postprocedural verification of the correct catheter position is usually done by chest radiography. Additionally, cleaning the catheter site, changing dressings regularly, and not keeping the catheter for unnecessarily long periods reduce infection rates. In conclusion, central venous catheterization plays vital roles in the management of critically ill patients. After the integration of ultrasonographic guidance and modern technologies, this procedure has become safer and more effective. Unnecessary use of central venous catheter must be avoided and the catheter must be removed immediately when the need ceases.

Keywords: Catheterization; Central venous; Ultrasonography; Jugular veins; Subclavian vein; Femoral cein; Critical care

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