Difficult Central Venous Access

Central venous catheterization, or central line placement, was first described in 1929 by Werner Forssman, a surgical intern who catheterized his own heart through his cephalic vein. This bold procedure later earned him the 1956 Nobel Prize and has had a significant impact in the practice of and delivery of modern medicine to both stable and critical patients.

Central venous access has had a great impact on improving longevity and quality of life. Renal replacement therapy, percutaneous coronary interventions, total parenteral nutrition (TPN), and cancer chemotherapy are extreme examples of such advances.

As central vascular access becomes more common and increasingly recognized as a standard requirement in many treatment regimens, the difficulty of obtaining it also grows. Previous attempts at placement of central venous catheters can make further attempts difficult or even preclude its use in the same vascular territory. In addition, modern self-destructive behaviors, such as intravenous (IV) drug abuse, have developed a whole new disease state that has forced medical providers to adapt and take a more innovative approach to vascular access.