emDocs - February 13, 2020 - By DeVivo A
Reviewed by: Koyfman A, Long B and Singh M
"Introduction
The ability to obtain rapid IV access in any patient, regardless of the clinical scenario, is a quintessential skill practiced by emergency physicians. While most patients in the ED will simply require peripheral IV access, the vignettes above present two critically-ill patients in very different circumstances, both of whom will likely require central venous catheter (CVC) placement. While the location of insertion is vital in certain scenarios, it does not define a CVC. A CVC is actually defined as a catheter whose tip resides within the superior vena cava, inferior vena cava, or at the junction between the vena cava and the right atrium (cavoatrial junction). Central venous access is obtained via the readily utilized Seldinger technique, in which a catheter is placed over a guidewire that has been threaded into a vessel through an introducer needle. The Seldinger technique is the foundation of most intravascular procedures and can be utilized for both peripheral and central venous catheters. The methodology has evolved over the past several decades and is now performed with or without ultrasound guidance, both of which techniques we will discuss below. This article will focus on the placement of CVCs including indications, contraindications, site choice, and complications. In addition, we will discuss the current literature behind the insertion site options and when pathophysiology should play a role in this decision. Since there are a variety of approaches and subtypes of catheters that can be placed depending upon the clinical scenario, the conclusion of this article will specifically review the placement of an internal jugular triple lumen catheter. Further posts under this broad overview will continue to discuss alternative approaches and catheter subtypes..."