• Measurement of central venous pressure (CVP):
  • Transfusion of large volumes of fluid required (the fluid itself can be given faster via a large-bore peripheral IV cannula)
  • Fluid challenge in patients with oliguria or hypotension
  • To exclude hypovolaemia when clinical evidence is equivocal
• Monitoring venous oxyhaemoglobin saturation
• Cardiac output monitoring with a pulmonary artery catheter
• Insertion of a temporary pacing lead (see Chapter 119) or pulmonary artery catheter
• IVC filter placement
• Administration of some drugs (e.g. epinephrine, norepinephrine and dopamine) and IV feeding solutions, which have to be given via a central vein
• Renal replacement therapy and plasmapheresis
• No suitable peripheral veins for IV infusion
• Pacemaker/cardiac device placement

Contraindications

• Bleeding disorder (including platelet count <50×10⁹/L, INR >1.5, receiving oral anticoagulant or anticoagulant-dose heparin, during or after thrombolytic therapy): discuss management with a haematologist. If central venous access is needed urgently, before the bleeding disorder can be corrected, use the femoral vein in preference to the internal jugular vein.
• Prohibitive anatomic distortion
• Local infection

Potential complications

During placement

• Arterial puncture or laceration, which in the case of the carotid artery may lead to haematoma formation in the neck, with compromise of the airway. Seek vascular surgical advice.
• Pneumothorax (via internal jugular or subclavian vein) or tension pneumothorax
• Haemothorax
• Cardiac tamponade (can be caused by central venous catheter introduced by any route, if its tip lies below the pericardial reflection and it perforates the vessel wall; least likely via internal jugular vein).
• Injury to adjacent nerves
• Air embolism

After placement

• Infection
• Venous thrombosis