CENTRAL VENOUS CATHETERS - PLACEMENT AND MONITORING TIPS

The Food and Drug Administration has recommended that central venous c atheterization be performed ''only when the potential benefits appear to outweigh the inherent risks of the procedure.''(1) When central acc ess is needed, the insertion site should be chosen according to the pa tient's needs. With the exception of pulmonary artery catheters, trans venous catheters, and possibly very soft Silastic catheters that are t o be used for an extended period, catheter tips should not enter the h eart; 30-cm central venous catheters should be avoided. Use of right a trial electrocardiography or formulas based on patient height may impr ove the accuracy of initial placement. Chest radiographs should confir m the extracardiac position of the catheter tip. Sudden cardiorespirat ory difficulty or chest pain in a patient with a central venous cathet er should prompt evaluation for vascular erosion from catheter tip mig ration.