Clinical Review

Central venous catheters

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6570 (Published 11 November 2013) Cite this as: BMJ 2013;347:f6570
  1. Reston N Smith, specialty registrar in anaesthesia and intensive care medicine1,
  2. Jerry P Nolan, consultant in anaesthesia and intensive care medicine 2
  1. 1North Bristol NHS Trust, Bristol, UK
  2. 2Royal United Hospital NHS Trust, Bath, UK
  1. Correspondence to: J P Nolan jerry.nolan{at}nhs.net

Summary points

  • A wide variety of central venous catheters are used

  • Complications related to central venous catheters are common and may cause serious morbidity and mortality

  • Several strategies can reduce central venous catheter related morbidity; these are implemented at catheter insertion and for the duration of its use

  • Peripherally inserted central catheters have the same, or even higher, rate of complications as other central venous catheters

Central venous catheterisation was first performed in 1929 when Werner Frossman, a German doctor, inserted a ureteric catheter into his antecubital vein. He then walked to the radiography department so that the catheter could be guided into his right ventricle using fluoroscopy. Since then, central venous access has become a mainstay of modern clinical practice. An estimated 200 000 central venous catheters were inserted in the United Kingdom in 1994,1 and the figure is probably even higher today. Clinicians from most medical disciplines will encounter patients with these catheters. Despite the benefits of central venous lines to patients and clinicians, more than 15% of patients will have a catheter related complication.2 This review will provide an overview of central venous catheters and insertion techniques, and it will consider the prevention and management of common complications.

Sources and selection criteria

We searched the Cochrane Database of Systematic Reviews, Medline, Embase, and Clinical Evidence online. Search terms included central venous catheter, peripherally inserted central catheter, and complication. The reference lists of relevant studies were hand searched to identify other studies of interest. We also consulted relevant reports and national guidelines.

What are central venous catheters?

A central venous catheter is a catheter with a tip that lies within the proximal third of the superior vena cava, the right atrium, or the inferior vena cava. Catheters can be inserted through a peripheral vein or a proximal central vein, most commonly the internal jugular, subclavian, or femoral vein. …

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