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.