When is a CVC indicated?

A central venous catheter should be used ( Kirby) when an IV catheter is not sufficient for the intended clinical therapy and it is necessary to have access to a large blood vessel. Such situations could include:

• Rapid administration of high volume substitution and/or aggressive drugs
• Administration of fluids or drugs when the peripheral vessels have collapsed (shock)
• Administration of irritating drugs (e.g. catecholamines, chemotherapeutic agents)
• Administration of high-osmolarity solutions (> 800 osm/l), e.g. for parenteral nutrition
• Therapies lasting several days or weeks which require a venous access
• Vein-venous hemofiltration (dialysis)
• Measurement of central venous pressure during or after an operation

Central venous catheters have become an indispensable tool in anesthesia, critical care and emergency medicine. Their use is a standard element of modern medical practice.

The correct positioning of the central venous catheter is of key significance for therapeutic success.
For most applications, placement in the superior vena cava approximately 2 cm before the opening into the right atrium is viewed as the optimal position for the catheter tip. The high rate of blood flow in this area guarantees a rapid dilution and distribution of infused solutions and drugs.