![]() Likewise, the ARDS network recently reported that CVP monitoring utilizing a CVC is as effective as a pulmonary artery catheter in managing patients with acute lung injury and ARDS. For these patients, the relationship between superior vena caval and inferior vena caval oxygen saturations has not been elucidated therefore, at this time we recommend superior vena caval catheterization through the SV, IJV, or EJV for this patient population. Early goal-directed therapy was subsequently shown to be achievable in “real world” settings. ![]() ![]() showed a 16% absolute reduction of in-hospital mortality with early goal directed therapy for patients with severe sepsis, which included keeping the ScvO 2 greater than 70%. The placement of central venous catheters is now also specifically indicated for patients with severe sepsis, septic shock, or acute respiratory distress syndrome (ARDS), in order to monitor central venous oxygen saturation (ScvO 2 and central venous pressure (CVP). General purpose venous access, vasoactive agents, caustic medications, radiologic procedures with coagulopathyĬentral venous oxygen satuation monitoringįluid management of ARDS (CVP monitoring)ĪV, antecubital vein CVP, central venous pressure EJV, external jugular vein FV, femoral vein IJV, internal jugular vein L, left PICC, peripherally inserted central venous catheter R, right SV, subclavian vein. Hypovolemia, inability to perform peripheral catheterization Pulmonary artery catheterization with coagulopathy with pulmonary compromise or high-level positive end-expiratory pressure (PEEP) Indications for Central Venous Catheterization If circulation is not restored after administration of appropriate drugs and defibrillation, central access should be obtained by the most experienced operator available with a minimum interruption of CPR. Prolonged attempts at arm vein cannulation are not warranted, and under these circumstances the FV is a good alternative because, despite the potential of longer drug circulation times, cardiopulmonary resuscitation (CPR) is interrupted the least with its placement. Effective drug administration is an extremely important element of successful cardiopulmonary resuscitation venous access should be established as quickly as possible, either peripherally or centrally if qualified personnelĪre present. Drugs injected through femoral catheters also have a prolonged circulation time unless the catheter tip is advanced beyond the diaphragm, although the clinical significance of this is debated. Peripheral vein cannulation in circulatory arrest may prove impossible, and circulation times of drugs administered peripherally are prolonged when compared to central injection. Venous access during cardiopulmonary resuscitation warrants special comment. In this chapter, we review the techniques and complications of the various routes available for central venous catheterization and present a strategy for catheter management that incorporates all of the recent advances. ![]() Inexplicably, many ICUs still have not incorporated these protocols into standardized daily practices. The implication is that any ICU can duplicate these experiences, independent of budget or specialty, using appropriate management and empowerment of bedside caregivers. Of significant note, this zero incidence of CRI was primarily achieved not through new catheter technology but rather by adherence to strict catheter insertion and maintenance protocols. That experience was duplicated by several other medical-surgical ICUs across the state of Michigan participating in the Keystone Project. Since the publication of the previous edition of this textbook, a significant milestone in CVC management was achieved with the report of a sustained zero incidence of catheter-related infection (CRI) in a clinical setting of a complicated medical-surgical ICU. Placement of central venous catheters (CVC) remains one of the most commonly performed procedures in the intensive care unit (ICU).
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