Long-term venous access: indications and choice of site and catheter.

Advances in treatment of malignancy, infection, renal failure, and malnutrition have expanded the need for long-term venous access. The placement of central venous catheters (CVC) requires preoperative evaluation to identify associated risk factors such as coagulopathy, thrombocytopenia, leukopenia, and variations in the vascular anatomy. When selecting a venous access catheter, it is important to consider its purpose, duration, and who will maintain it. The technique of inserting a catheter into the central venous system has become standardized by Seldinger. Catheters now are prepackaged in kits equipped for percutaneous placement. Knowledge of the technical aspects of placing a CVC can prevent early occlusion and dislodgment. With the increasing numbers of CVCs being inserted, it is possible to overuse the common sites for placement. We describe techniques that have been developed to use alternate routes for venous access.