Central Line Insertion & Bundle

Central venous catheters (CVCs) provide reliable large-bore access to the central venous circulation for medication administration (vasopressors, hypertonic solutions, total parenteral nutrition), hemodynamic monitoring (CVP), rapid volume resuscitation, and prolonged IV therapy (>7 days). Common insertion sites: internal jugular (preferred for most indications - lower risk of pneumothorax than subclavian, lower infection rate than femoral), subclavian (lowest infection rate but highest pneumothorax risk, avoid in coagulopathy), and femoral (easiest insertion but highest infection rate, reserved for emergencies). The catheter tip should be positioned at the junction of the SVC and right atrium, confirmed by chest X-ray. Central line-associated bloodstream infection (CLABSI) is the most serious complication, with attributable mortality of 12-25% and cost of $45,000 per episode. CLABSI results from migration of skin organisms along the external catheter surface or contamination of the catheter hub. The most common pathogens are coagulase-negative staphylococci (most frequent), S. aureus (most lethal), enterococci, and Candida species. The Central Line Bundle (evidence-based practices that dramatically reduce CLABSI when implemented together) was developed by the IHI and has reduced CLABSI rates by 50-70%.