Each VAD whose tip is placed in the superior vena cava, or in the right atrium, or in the inferior vena cava is defined as 'central'. Any other device whose tip is in another venous district is classified as 'peripheral'.
The choice between central venous access and peripheral venous access depends on the type of use. The common indications to central VAD are:
1 - need for intravenous infusion of drugs and solutions not compatible with the peripheral route because potentially associated with endothelial damage: this category include vesicant drugs, drugs with pH higher than 9 or less than 5, markedly hyperosmolar solutions (above 800-850 mOsm/liter) and many other drugs that with different mechanisms, even independent of pH and osmolarity, are able to cause irritation and/or damage to the endothelium; lists of peripherally compatible and incompatible drugs can be found on the web (e.g. on our website www.gavecelt.info) or in textbooks (such as in the GAVeCeLT Manual of PICCs and Midlines);
2 - need for hemodialysis procedures (for which dedicated devices are required: as already explained - they will not be treated in this algorithm);
3 - need for repeated and frequent blood samples;
4 - need for hemodynamic monitoring (oxygen saturation in mixed venous blood; measurement of central venous pressure; use for thermodilution technique for cardiac output); this use is possible only with those central venous catheters whose tip is in the right atrium.
