Emergency Medicine

CENTRAL LINE INSERTION

476 Practical Procedures

COMPLICATIONS

1 Myocardial damage, coronary artery laceration and cardiac arrhythmias.

2 Pneumothorax.

3 Hepatic injury.

CENTRAL LINE INSERTION

INDICATIONS

1 Inability to obtain timely/adequate peripheral IV access in critically unwell

patient.

2 Intravenous administration of certain drugs (e.g. adrenaline [epinephrine],

noradrenaline [norepinephrine]).

3 Centra l venous pressure monitoring in critica lly unwell patient.

4 Large-bore i.v. access for rapid volume resuscitation (or haemodialysis/

plasmapheresis).

5 Hyperalimentation such as total parenteral nutrition (TPN) administration.

6 Long-term chemotherapy/antibiotics (e.g. Hickman’s line).

CONTRAINDICATIONS

1 Uncooperative patient.

2 Less invasive form of i.v. access possible and adequate.

Figure 18.2 Pericardial aspiration.