Guia De Cateter

Practice Guidelines for Central Venous Access
A Report by the American Society of Anesthesiologists Task Force on Central Venous Access

P

RACTICE Guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints, and arenot intended to replace local institutional policies. In addition, Practice Guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice Guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basicrecommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data.

Methodology
A. Definition of Central Venous Access For these Guidelines, central venous access is defined as placement of a catheter such that the catheter is inserted into a venous great vessel. The venous great vesselsinclude the superior vena cava, inferior vena cava, brachiocephalic veins,
Developed by the American Society of Anesthesiologists Task Force on Central Venous Access: Stephen M. Rupp, M.D., Seattle, Washington (Chair); Jeffrey L. Apfelbaum, M.D., Chicago, Illinois; Casey Blitt, M.D., Tucson, Arizona; Robert A. Caplan, M.D., Seattle, Washington; Richard T. Connis, Ph.D., Woodinville, Washington; KarenB. Domino, M.D., M.P.H., Seattle, Washington; Lee A. Fleisher, M.D., Philadelphia, Pennsylvania; Stuart Grant, M.D., Durham, North Carolina; Jonathan B. Mark, M.D., Durham, North Carolina; Jeffrey P. Morray, M.D., Paradise Valley, Arizona; David G. Nickinovich, Ph.D., Bellevue, Washington; and Avery Tung, M.D., Wilmette, Illinois. Received from the American Society of Anesthesiologists, Park Ridge,Illinois. Submitted for publication October 20, 2011. Accepted for publication October 20, 2011. Supported by the American Society of Anesthesiologists and developed under the direction of the Committee on Standards and Practice Parameters, Jeffrey L. Apfelbaum, M.D. (Chair). Approved by the ASA House of Delegates on October 19, 2011. Endorsed by the Society of Cardiovascular Anesthesiologists,October 4, 2010; the Society of Critical Care Anesthesiologists March 16, 2011; the Society of Pediatric Anesthesia March 29, 2011. A complete list of references used to develop these updated Guidelines, arranged alphabetically by author, is available as Supplemental Digital Content 1, http://links.lww.com/ALN/A783. Address correspondence to the American Society of Anesthesiologists: 520 NorthNorthwest Highway, Park Ridge, Illinois 600682573. These Practice Guidelines, as well as all ASA Practice Parameters, may be obtained at no cost through the Journal Web site, www.anesthesiology.org. * This description of the venous great vessels is consistent with the venous subset for central lines defined by the National Healthcare Safety Network (NHSN).
Copyright © 2012, the American Society ofAnesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology 2012; 116:539 –73

• What other guideline statements are available on this topic? X Several major organizations have produced practice guidelines on central venous access128 –132 • Why was this Guideline developed? X The ASA has created this new Practice Guideline to provide updated recommendations on some issues and newrecommendations on issues that have not been previously addressed by other guidelines. This was based on a rigorous evaluation of recent scientific literature as well as findings from surveys of expert consultants and randomly selected ASA members • How does this statement differ from existing guidelines? X The ASA Guidelines differ in areas such as insertion site selection (e.g., upper body site)...