Central

Central venous access refers to the placement of a catheter with its tip positioned in one of the large veins close to the heart, known as central veins. These include the superior vena cava, inferior vena cava, and right atrium. This is distinct from a peripheral intravenous line, which is placed in a smaller vein in the arm or hand.

A central line (central venous catheter, CVC) provides reliable, long-term access for administering medications that would damage smaller peripheral veins, such as vasopressors, concentrated potassium, and parenteral nutrition. It also allows measurement of central venous pressure (CVP), which reflects filling pressure in the right heart and is used to guide fluid management. Central lines are inserted under local anaesthetic, using ultrasound guidance to locate the target vein safely.

In the intensive care unit following cardiac arrest, a central line is typically placed during initial post-resuscitation management. It provides access for vasopressor infusions, sedation, and other time-critical drugs that cannot be given safely through a peripheral cannula. Common insertion sites include the internal jugular vein in the neck, the subclavian vein below the collar bone, and the femoral vein in the groin. The position of the tip is confirmed by chest X-ray before the line is used.

Risks associated with central venous access include pneumothorax (collapsed lung from the needle puncturing the pleural space), arterial puncture, infection, air embolism, and thrombosis. These complications are uncommon when the procedure is performed by experienced staff using ultrasound guidance and aseptic technique. The line is removed as soon as the clinical need has passed, typically once the patient is stable enough to receive medication through a peripheral cannula.