when do i put a central line or indications of putting central line these days

[frontier]

sirs,
i expect you people will be giving your ideas.
             regards

[yogenbhatt1]

Indication of CVP line.
Simple, when ever you think of it.
Let us speak of it from indication in private practice in Indian scenario.
A patient of perforative peritonitis, for surgery. The moment you induce them, they crash, as the CVP is too low.
Any other septic shock patient. Specially the E coli type.
Inavailability of peripheral lines, specially MRM patients, who have recd one cycle of Chemo, now all veins are fired and other arm cant be used for IV. Better would be a port if possible.
An IT fracture. The patients do not consume fluids with a fear of pain while asking for a pot for urination. These elderly patients are in dehydration, and hence the hemoconcentration, showing us good Hb level, which in reality is quite low. Check S. Creat, it may be higher.
A supramajor abdomenal surgery, where drugs like Pegleg are given to empty the bowels. There is gross dehydration and electrolyte disturbance in these cases due to this. At times CVP is zero to start with. We also give Epidural as an addition to GA in these cases. They give you a tough time.
An onco surgery where many pints of fluids and blood or plasma expanders will be needed.
A patiet with low ejection fraction, one would rather put in a line.
And so on.
No one objects if you can justify the decision.
Will add more when I think of it.
Regards.
There may be points against these, depending upon the place where one is working.