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2026
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| Online Access: | https://doi.org/10.5281/zenodo.20376478 |
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| author | Indunil Karunarathna |
| author_facet | Indunil Karunarathna |
| contents | <p class="MsoNormal"><span>Central venous catheterization (CVC) is one of the most frequently performed procedures in acute and critical care medicine, yet it carries a unique duality: when performed correctly, it is life-saving; when performed poorly, it can be life-threatening. This review provides a comprehensive, clinically grounded examination of CVC placement and management, emphasizing the three primary access sites for temporary central access—the internal jugular, subclavian, and common femoral veins. The Seldinger technique, introduced in the 1960s, remains the procedural gold standard, though the adjunctive use of real-time ultrasound guidance has revolutionized practice, particularly for internal jugular cannulation, where it significantly reduces mechanical complications and improves first-pass success. Key indications include vasopressor support, hemodynamic monitoring, administration of hyperosmolar or vesicant agents, inadequate peripheral venous access, and extracorporeal therapies such as hemodialysis. Contraindications range from absolute (active infection at the site) to relative (coagulopathy, thrombocytopenia), each requiring thoughtful bedside risk-benefit assessment. Complications are broadly divided into procedural (arrhythmias, arterial puncture, pneumothorax, bleeding, air embolism) and post-procedural (catheter-related bloodstream infections, central vein stenosis, thrombosis). Perhaps the most underappreciated clinical pearl is this: the single most effective intervention to reduce catheter-related complications is not a better insertion technique but rather the daily, disciplined reassessment of whether the line is still needed—and its prompt removal when it is not. Effective CVC outcomes depend not only on technical skill but also on meticulous preparation, strict adherence to sterile protocols, confirmatory post-placement imaging, and robust interprofessional teamwork involving physicians, nurses, and allied health staff. This review aims to equip clinicians with the cognitive frameworks and practical heuristics necessary to perform and manage central venous catheterization safely, efficiently, and compassionately.</span></p> |
| format | Recurso digital |
| id | zenodo_https___doi_org_10_5281_zenodo_20376478 |
| institution | Zenodo |
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| publishDate | 2026 |
| publisher | Zenodo |
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| spellingShingle | Central Venous Catheterization: Indications, Anatomy, Technique, Complications, and Management—A Practical Review for the Bedside Clinician Indunil Karunarathna <p class="MsoNormal"><span>Central venous catheterization (CVC) is one of the most frequently performed procedures in acute and critical care medicine, yet it carries a unique duality: when performed correctly, it is life-saving; when performed poorly, it can be life-threatening. This review provides a comprehensive, clinically grounded examination of CVC placement and management, emphasizing the three primary access sites for temporary central access—the internal jugular, subclavian, and common femoral veins. The Seldinger technique, introduced in the 1960s, remains the procedural gold standard, though the adjunctive use of real-time ultrasound guidance has revolutionized practice, particularly for internal jugular cannulation, where it significantly reduces mechanical complications and improves first-pass success. Key indications include vasopressor support, hemodynamic monitoring, administration of hyperosmolar or vesicant agents, inadequate peripheral venous access, and extracorporeal therapies such as hemodialysis. Contraindications range from absolute (active infection at the site) to relative (coagulopathy, thrombocytopenia), each requiring thoughtful bedside risk-benefit assessment. Complications are broadly divided into procedural (arrhythmias, arterial puncture, pneumothorax, bleeding, air embolism) and post-procedural (catheter-related bloodstream infections, central vein stenosis, thrombosis). Perhaps the most underappreciated clinical pearl is this: the single most effective intervention to reduce catheter-related complications is not a better insertion technique but rather the daily, disciplined reassessment of whether the line is still needed—and its prompt removal when it is not. Effective CVC outcomes depend not only on technical skill but also on meticulous preparation, strict adherence to sterile protocols, confirmatory post-placement imaging, and robust interprofessional teamwork involving physicians, nurses, and allied health staff. This review aims to equip clinicians with the cognitive frameworks and practical heuristics necessary to perform and manage central venous catheterization safely, efficiently, and compassionately.</span></p> |
| title | Central Venous Catheterization: Indications, Anatomy, Technique, Complications, and Management—A Practical Review for the Bedside Clinician |
| url | https://doi.org/10.5281/zenodo.20376478 |