The role of IVs and central lines in critical care

A guest column by the American Society of Anesthesiologists, exclusive to

As a critical care anesthesiologist, I care for patients when they are most vulnerable. Critical care patients require intravenous (I.V.) fluids and medications, frequently through central venous access. These are catheters inserted into larger veins with a special procedure. I believe managing I.V. lines requires procedural skills, managing risks with benefits and the recognition of alternative access options.

Clinicians in critical care settings frequently care for patients who may present a challenge in establishing regular I.V. lines. These patients often include those who are obese, have vascular/connective tissue disease, or receive steroid therapy or chemotherapy. Also, patients who have had multiple previous I.V. attempts may have difficulty. Some of these patients may need central venous access.

The risks of central venous access must be weighed against the benefits. Risks include infection, bleeding or the puncture of internal organs. However, benefits include the improved monitoring of cardiovascular function and the safer delivery of blood pressure and intravenous nutrition drugs.

Clinicians should think about how to care for various I.V. devices and when central venous access should be discontinued. They should understand some low-resistance lines, such as those used for dialysis, often need anticoagulant flushes, while other lines with valves, intended for long-term access, generally do not require heparin flushes. An emphasis on meticulous sterile technique, both during the placement of lines and during routine care, is essential. Removal of unused lines reduces infection risk.

If you are a patient who is at risk or are concerned about I.V. access, it is important to discuss your concerns with your health care provider. Clinicians can explain the benefits and risks of I.V. lines or central venous access and provide safety information. They also can discuss alternative I.V. site locations, if needed.

I enjoy caring for the patients in my hospital who need it most. I will always value the important responsibility of critical care physicians to make quick, life-saving decisions.

Mark E. Nunnally is Chair, ASA Committee on Critical Care Medicine. 

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