Each catheter whose tip is positioned in the superior vena cava, or in the right atrium, or in the inferior vena cava can be defined as 'central' venous access. 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 envisaged for the device. The indications to a device for central venous access are the following:
1 - need for intravenous infusion of drugs and solutions not compatible with the peripheral route because they are potentially associated with endothelial damage: this category includes 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 non-compatible drugs can be found on the web (e.g., on our website www .gavecelt.info) or in textbooks (such as in the GAVeCeLT Manual for PICCs and Midlines);
2 - need for hemodialysis procedures (for which dedicated devices are required; this aspect -as already explained - will not be treated in this algorithm);
3 - need for repeated and frequent blood samples;
4 - need for hemodynamic monitoring (dosage of oxygen saturation in mixed venous blood; measurement of central venous pressure; use of the line for thermodilution technique to estimate cardiac output); this use is possible only with those central venous catheters whose tip is in the superior vena cava or in the right atrium.
