Central Line Awareness

A central vascular access device is a catheter whose tip rests in a central vein, generally the superior or inferior vena cava. A peripherally inserted central catheter, or PICC, enters through a vein in the arm but still qualifies as central access because of where its tip ends. Other devices include non-tunneled and tunneled catheters, implanted ports, and catheters designed for dialysis. Central veins carry a large, rapidly moving volume of blood. That flow dilutes medications and solutions that could irritate or damage a small peripheral vein. Central access is therefore used when peripheral access is unsuitable or when treatment requires central administration, such as continuous vesicant therapy or a solution with osmolarity greater than 900 mOsm/L. Total parenteral nutrition, some vasopressors, selected prolonged infusions, and hemodynamic monitoring may also require a device suited to central access. The catheter is not simply an extra IV. Each lumen, connector, clamp, dressing, and segment of exposed tubing creates a possible route for contamination or mechanical failure. A central-line infection may begin when skin organisms migrate along the catheter tract, when a hub...