Percutaneous central venous catheters--a continuum of use.

Percutaneous central venous catheterization provides access for volume replacement and hemodynamic monitoring. This study reviewed 119 percutaneous central venous catheterizations in 112 patients over a 12-month period. All catheters were placed by emergency department (ED) physicians or housestaff under their direct guidance. Pneumothorax occurred in three patients and required chest tube insertion in one patient. Eighty-seven patients were admitted to the critical care units directly from the ED. In 26 (30%) patients, the central lines were converted to pulmonary artery catheters. Nineteen patients were admitted directly to the operating room, where the central venous line was used for volume replacement and monitoring. Postoperatively, five (26%) of these were converted to pulmonary artery catheters. Central venous catheters can be placed in patients percutaneously in the emergency department with minimal morbidity. They provide initial access to the central circulation for resuscitation and subsequently can be converted to pulmonary artery catheters for hemodynamic monitoring.