Central Venous Catheter (CVC)


Central Venous Access to Facilitate Venous Intravascular Procedures

  • Inferior Vena Cava (IVC) Filter Insertion (see Inferior Vena Cava Filter)
  • Temporary/Transvenous Pacemaker Wire Insertion
  • Venous Stenting
  • Venous Thrombolysis for the Treatment of Deep Venous Thrombosis (DVT) (see Deep Venous Thrombosis)

Intravenous Infusion of Total Parenteral Nutrition (TPN) (see Total Parenteral Nutrition)

  • Common Indication

Intravenous Infusion of Vasoactive Medications

Agents in Which Administration Via Central Venous Catheter is Recommended

Clinical Efficacy

  • French Randomized Trial Comparing Risks and Benefits of Central Venous Catheter (CVC) vs Peripheral Intravenous Catheter Access in Intensive Care Unit (ICU) Patients (Crit Care Med, 2013) [MEDLINE]: randomized cross-over trial studying assignment of initial venous access in 3 French ICU’s (n = 135 CVC’s + 128 non-midline peripheral IV’s)
    • Study Endpoints
      • Primary: 28-day incidence of major catheter-related complications
        • Mechanical Complications: pneumothorax, arterial puncture, hematoma, CVC insertion site changes, peripheral venous catheter insertion difficulty, infiltration
        • Infectious Complications: erythema, phlebitis, bacteremia, catheter-related infection
        • Thrombotic Complications: venous thrombosis
      • Seconary
        • Minor Complications
        • Mortality
        • Amount of Medical/Paramedical Time Used
    • Significantly Increased Major Catheter-Related Complications were Observed in the Peripheral Intravenous Catheter Group (133), as Compared to the Central Venous Catheter (CVC) Group (87) (p = 0.02)
    • Trend Toward Increased Minor Catheter-Related Complications was Observed in Peripheral Intravenous Catheter Group (248), as Compared to the Central Venous Catheter (CVC) Group (251) (p = 0.06)
    • No Difference in Kaplan-Meier Probabilities of Survival Between the Groups
  • CENSER Trial of Early Norepinephrine Use in Septic Shock (Am J Respir Crit Care Med, 2019) [MEDLINE]
    • Only 6 Adverse Events (Related to Peripheral Vasopressor Use) Occurred in the Early Vasopressor Group (3.8%)
      • 1 Patient with Skin Necrosis
      • 5 Patient with Acute Limb or Intestinal Ischemia
  • Retrospective Cohort Study of the Safety of Peripheral Vasopressor Administration (J Intensive Care Med, 2019) [MEDLINE]: n = 202
    • Incidence of Extravasation was 4%
      • All of the Events were Managed Conservatively (None Required an Antidote or Surgical Management)
      • Vasopressors were Restarted at Another Peripheral Site in 88% of the Events
  • Systematic Review and Meta-Analysis of Peripheral Vasopressor Administration (Am J Emerg Med, 2020) [MEDLINE]: n = 1,835
    • Approximately 7% of Patients Had Complications
      • Approximately 96% of the Complications were Minor
    • Meta-Analysis with Random Effects Demonstrated the Pooled Prevalence of Complications as 0.086 (95% CI: 0.031-0.21)
    • Studies Reporting Infusion Safety Guidelines Had Significantly Lower Prevalence of Complications (0.029; 95% CI: 0.018-0.045), as Compared to Those Not Reporting a Safety Guideline (0.12; 95% CI: 0.038-0.30, p = 0.024)
  • Single Center retrospective Observational Study of Peripheral vs Central Administration of Vasopressors (Aust Crit Care, 2022) [MEDLINE]: n = 212
    • Importantly, There were Baseline Differences Between the Groups Group 1 (Peripheral Only) Had the Lowest Median Acute Physiology and Chronic Health Evaluation III Score (64, Interquartile Range: 44-77) and Group 3 (Central Only) Had the Highest (86; Interquartile Range: 57-101)
    • There were No Major Complications
    • However, Minor Complications (Leakage, Extravasation, and Erythema) Occurred in 41% of Group 1 (Peripheral Only) and 28% of Group 2 (Peripheral Followed by Central) Patients
    • Duration of Peripheral Vasopressor Infusion was Not Associated with an Increased Risk of Complications
  • Rwandan Prospective Cohort Study of Peripheral Vasopressor Administration in Critically Ill Patients (Afr J Emerg Med, 2022) [MEDLINE]: n = 64
    • Median Treatment Duration was 19 hrs (IQR: 8.5-37 hrs)
    • Treatment Discontinuation was Predominantly Due to Mortality (41%) or Resolution of Instability (36%)
    • There were Two Extravasation Events (2.9%), Both Limited to Soft Tissue Swelling
    • Extravasation Incidence was 0.8 Events Per 1,000 Patient-Hours (95% CI: 0.2-2.2)
  • Prospective Observational Cohort Study of the Peripheral Administration of Norepinephrine (Chest, 2023) [MEDLINE]: n = 635
    • Protocol for Peripheral Norepinephrine Administration was Developed and Implemented in the Medical Intensive Care Unit
    • Median Number of Central Venous Catheter Days Avoided Per Patient was 1 Day (Interquartile Range: 0-2 Days Per Patient)
    • Of the 603 Patients Who Received Norepinephrine Peripherally as the First Norepinephrine Exposure, 51.6% of Patients Never Required Central Venous Catheter Insertion
  • CLOVERS Trial of Fluid Resuscitation Strategies in Sepsis (NEJM, 2023) [MEDLINE]: n = 1,563
    • There were 3 Events (Related to Peripheral Vasopressor Use) in Peripheral IV Catheter Vasopressor Group (Out of n = 500), All 3 were Site Extravasations
  • Review of Studies of Adverse Events with Peripheral Vasopressor Administration (Cleve Clin J Med, 2024) [MEDLINE]
    • Authors Suggested a Protocol-Based Approach to Decrease Risk of Adverse Events with Peripheral Vasopressor Administration

Inadequate Peripheral Venous Access

  • Common Indication

Intravenous Administration of Other Medications

Intravenous Fluid Resuscitation in Hypotension/Shock States (see Hypotension)

  • Cardiogenic Shock (see Cardiogenic Shock)
  • Distributive Shock
    • Anaphylactic Shock/Anaphylaxis (see Anaphylaxis)
    • Septic Shock/Sepsis (see Sepsis)
    • Systemic Inflammatory Response Syndrome (SIRS) (see Sepsis)
    • Endocrine/Nutritional Deficiency-Associated Hypotension
    • Hematologic Disease-Associated Hypotension
    • Neurogenic Shock (see Neurogenic Shock)
    • Drug/Toxin-Associated Hypotension
  • Hemorrhagic Shock (see Hemorrhagic Shock)
  • Hypovolemic Shock (see Hypovolemic Shock)
  • Obstructive Shock

Monitoring of Central Venous Pressure (CVP) (see Hemodynamics)

  • Common Indication


Background-Internal Jugular Venous Anatomy

Use of Ultrasound-Guidance During Central Venous Catheter (CVC) Placement

General Comments

Use of Ultrasound in the Internal Jugular Vein Location

Use of Ultrasound in Subclavian Location

Use of Ultrasound in Femoral Location

Use of Ultrasound in the Setting of Coagulopathy (see Coagulopathy)

Use of Ultrasound in the Subclavian Vein Location

Considerations for Central Venous Catheter (CVC) Placement in the Setting of Coagulopathy (see Coagulopathy)

Types of Coagulopathy

Site Selection in the Setting of Coagulopathy

Preprocedural Correction of Thrombocytopenia/Coagulopathy (see Thrombocytopenia and Coagulopathy)

Use of Ultrasound in the Setting of Coagulopathy

Recommendations for Central Venous Catheters (CVC’s) (CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections 2011) [LINK]

Recommendations (American Society of Diagnostic and Interventional Nephrology, Clinical Practice Committee and the Association for Vascular Access, 2008) (Semin Dial, 2008) [MEDLINE]

Adverse Effects/Complications

Mechanical Complications Associated with Central Venous Catheter (CVC) Insertion

General Comments

Types of Mechanical Complications

Air Embolism (see Air Embolism)

Central Venous Catheter (CVC) Infection (Including Central Line-Associated Bloodstream Infection, CLABSI)


Risk Factors for Central Venous Catheter Infection

Microbiology of Central Venous Catheter (CVC) Infection

Factors Which Decrease Bacterial Colonization of Central Venous Catheter (CVC)

Prevention of Central Venous Catheter (CVC) Infection

Impact/Prognosis of Central Venous Catheter (CVC) Infection

Factors influencing Management of Suspected Central Venous Catheter (CVC) Infection

Techniques to Manage Suspected Central Venous Catheter (CVC) Infection

Deep Venous Thrombosis (DVT) (see Deep Venous Thrombosis)

Types of Deep Venous Thrombosis (DVT)

Clinical Data

Septic Embolism to Lungs (see Septic Embolism)

Venous Stenosis (see Central Vein Stenosis)

Clinical Data




Vasopressor Administration


Adverse Effects/Complications