Practice Guidelines for Central Venous Access

TLDR

Practice guidelines are systematically developed recommendations that aid clinicians and patients in decision‑making, are not absolute standards, and evolve with medical knowledge. These guidelines aim to guide placement and management of central venous catheters, reduce related adverse outcomes, and improve handling of arterial trauma. The guidelines define central venous access as catheter placement into a major venous vessel and apply to elective procedures performed by anesthesiologists or supervised by them, excluding emergency, PICC, pulmonary artery catheter, and tunneled line scenarios. Methodology A.

Abstract

P RACTICE Guidelines are systematically developed rec- ommendations that assist the practitioner and patient in making decisions about health care.These recommendations may be adopted, modified, or rejected according to clinical needs and constraints, and are not intended to replace local institutional policies.In addition, Practice Guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome.Practice Guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice.They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data. Methodology A. Definition of Central Venous AccessFor these Guidelines, central venous access is defined as placement of a catheter such that the catheter is inserted into a venous great vessel.The venous great vessels include the superior vena cava, inferior vena cava, brachiocephalic veins, internal jugular veins, subclavian veins, iliac veins, and common femoral veins.*Excluded are catheters that terminate in a systemic artery. B. Purposes of the GuidelinesThe purposes of these Guidelines are to (1) provide guidance regarding placement and management of central venous catheters, (2) reduce infectious, mechanical, thrombotic, and other adverse outcomes associated with central venous catheterization, and (3) improve management of arterial trauma or injury arising from central venous catheterization. C. FocusThese Guidelines apply to patients undergoing elective central venous access procedures performed by anesthesiologists or health care professionals under the direction/supervision of anesthesiologists.The Guidelines do not address (1) clinical indications for placement of central venous catheters, (2) emergency placement of central venous catheters, (3) patients with peripherally inserted central catheters, (4) placement and residence of a pulmonary artery catheter, (5) insertion of tunneled central lines (e.g., permacaths, portacaths,