Short-term central venous catheters (CVCs), typically non-tunneled and intended for use up to 2–3 weeks, are commonly used in the intensive care unit (ICU) for critically ill patients. Their use is guided by specific clinical indications and the need for rapid, reliable central venous access.
When Should Short-Term CVCs Be Used?
Short-term CVCs are indicated in the ICU under the following circumstances:
- Hemodynamic Instability: When patients require vasoactive medications (e.g., vasopressors) that cannot be administered safely through peripheral veins.
- Need for Rapid or High-Volume Fluid Administration: In cases such as shock or major trauma where large volumes of fluids or blood products are needed quickly.
- Central Venous Pressure Monitoring: For accurate measurement of central venous pressure to guide fluid management in critically ill patients.
- Administration of Irritant or Vesicant Drugs: Such as certain antibiotics, chemotherapy, or parenteral nutrition, which can cause tissue damage if extravasated from a peripheral vein.
- Poor Peripheral Venous Access: When peripheral veins are inaccessible or inadequate for therapy.
- Renal Replacement Therapy: For acute dialysis or continuous renal replacement therapies in the ICU.
- Frequent Blood Sampling: When repeated blood draws are needed, a CVC can reduce the need for repeated peripheral venipuncture.
Why Use Short-Term CVCs in the ICU?
The rationale for using short-term CVCs in the ICU includes:
- Rapid Establishment of Reliable Venous Access: Critically ill patients often need immediate and reliable access for life-sustaining therapies.
- Multiple Lumen Availability: Allows simultaneous administration of incompatible medications or fluids.
- Short Duration of Therapy: Non-tunneled CVCs are preferred when central access is needed for days to a few weeks, as in most ICU scenarios.
- Emergency Situations: CVCs can be placed quickly at the bedside, making them suitable for urgent or emergent situations.
- Monitoring and Support: Enables advanced hemodynamic monitoring and support that peripheral lines cannot provide.
Key Considerations
- Duration: Short-term CVCs are typically used for less than 2–3 weeks. If central access is needed for longer, a peripherally inserted central catheter (PICC) or tunneled catheter may be preferred.
- Infection Risk: Short-term CVCs carry a risk of central line-associated bloodstream infection (CLABSI), which increases with duration and patient risk factors. Strict aseptic technique and daily assessment for necessity are essential.
- Site Selection: Subclavian vein is generally preferred over jugular or femoral sites in adults to reduce infection risk, unless contraindicated.
Short-term CVCs are essential in the ICU for critically ill patients who require rapid, reliable, and multi-lumen central venous access for a limited duration. Their use is justified by the need for advanced monitoring, administration of specific therapies, and situations where peripheral access is inadequate or unavailable. However, their use must be balanced against the risks of infection and other complications, with daily reassessment to remove the catheter as soon as it is no longer needed.
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References
Kolikof, J. et al., (2025, February 4) Central Venous Catheter Insertion. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK557798/
Kehagias, E. et al., (2023, May 25) Central venous catheters: Which, when and how. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC10607393/
Health Care Providers. (2024, February 8) Background Information: Strategies for Prevention of Catheter-Related Infections in Adult and Pediatric Patients. CDC. https://www.cdc.gov/infection-control/hcp/intravascular-catheter-related-infection/prevention-strategies.html
Becerra-Bolaños. Et al., (2025, January 10) Assessing infection related to short-term central venous catheters in the perioperative setting. Nature. https://www.nature.com/articles/s41598-025-85836-z