Special Considerations

Each patient situation is different; therefore, a full assessment of need and risk should be addressed when selecting and inserting vascular access devices. Although there are no absolute contraindications for CVC placement, in some clinical situations other forms of therapy may be more appropriate. Alternative forms of treatment may need to be approached for these specific patient populations:

• Severe coagulation disorders
• Severe obesity
• Long term renal
• Respiratory compromise
• Restless and uncooperative
• History of or known thrombus
• Medically unstable where the procedure does not supersede benefits

Severe coagulopathic patients have a higher risk of bleeding post insertion. Prior to catheter insertion coagulation studies should be done. These studies should include a current international normalization ratio (INR) typically less than 2.0 and a platelet count greater than 50,000. In clinical situations when CVC placement is emergent or medically warranted a compressible site such as internal jugular, axillary or femoral with ultrasound guidance should be used. In some situations coagulation disorders maybe temporarily reversed with blood products such as platelets, or temporary suspension of anticoagulants. Strict ultrasound guidance is advised in this patient population. Post insertion coagulation medians maybe necessary to attain stasis at the insertion site. Refer to your facility specific policy regarding specific insertion criteria.