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Central Venous Catheterization
Alan S. Graham, M.D., Caroline Ozment, M.D., Ken Tegtmeyer, M.D.,Susanna Lai, M.P.H., and Dana A.V. Braner, M.D.
Indications

Central venous catheterization provides a route for delivery of caustic or critical medications and allows measurement of central venouspressure.
Contraindications

General contraindications for the placement of a central venous catheter include infection of the area overlying the target vein and thrombosis of the target vein;site-specific and relative contraindications include coagulopathy, although this is not an absolute contraindication. Extreme care must be exercised in patients with coagulopathy and in other patients forwhom complications would be life-threatening.
Equipment

From the Department of Pediatrics, Division of Pediatric Critical Care, Doernbecher Children’s Hospital, Portland, OR (A.S.G., K.T., S.L.,D.A.V.B.); and the Department of Pediatrics, Division of Pediatric Critical Care, Duke University, Durham, NC (C.O.). Address reprint requests to Dr. Tegtmeyer at the Department of Pediatrics, Division ofPediatric Critical Care, Doernbecher Children’s Hospital, Oregon Health & Science University, Mail Code: CDRC-P, 707 SW Gaines St., Portland, OR 972392901, or at tegtmeye@ohsu.edu. N Engl J Med2007;356:e21.
Copyright © 2007 Massachusetts Medical Society.

Many institutions stock prepackaged catheter-insertion kits containing the necessary equipment. The catheter should have the appropriatelumen size to deliver the required medications, and its length should be appropriate to reach the junction of the vena cava and the right atrium. Approximate length can be measured against the patient’sexternal anatomical landmarks. Seven-French 20-cm catheters are the most commonly used. Dialysis or rapid fluid resuscitation requires larger-bore catheters. Each additional lumen decreases the...