Central venous catheterization.

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 for whom complications would be life-threatening. Equipment Many institutions stock prepackaged catheter-insertion kits containing the necessary equipment. The catheter should have the appropriate lumen 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’s external 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 size of the individual lumens, which will decrease the maximal rate at which fluids can be administered. The catheter should be flushed, and compatibility between the guide wire and the needle should be confirmed.