UNC VIR - Central venous access

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One of several options may be indicated by a request for “tunneled CVC”.
The appropriate type of central line can often be determined by looking at indication for the study listed on the procedure request or in the patient’s clinical notes (i.e., for antibiotics, chemotherapy, hemodialysis, apheresis, TPN, etc.)
When in doubt, contact the ordering service to clarify.
Has the patient had any prior central venous lines? When and at what site was last line placed? If the patient previously had a tunneled femoral HD catheter, they may have chronic venous occlusion.
Are there any recent chest CTs available? Is there evidence of central venous occlusion?
The laboratory value thresholds for safe placement vary depending on the type of access.

For antibiotics, chemotherapy, TPN, etc.
No specific INR or platelet threshold.
Single or dual lumen?
Creatinine level: relative contraindication in patients with renal insufficiency to preserve arm veins for future HD access.

For chemotherapy or general vascular access
INR < 1.5; Platelets > 50
Afebrile and blood cultures negative > 48hrs
No active sources of infection (i.e., intra-abdominal abscesses, diabetic foot ulcers, decubitus ulcers, etc.)
Single or dual lumen?

Indication: therapy completion vs. Infection
If removal is for infection, does the patient have or need another type of access (peripheral IV, temporary CVC, etc.)

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