Central venous catheters (CVCs) are widely used in US critical care settings, providing essential functions such as medication administration, hemodynamic monitoring, and reliable venous access. Despite the benefits of CVCs, complications, particularly infections, have become a major focus of US hospital quality improvement efforts due to federal and state initiatives that emphasize patient safety, transparency, and accountability. The Centers for Medicare & Medicaid Services mandate reporting hospital-acquired infections through the Hospital Inpatient Quality Reporting Program, which significantly affects hospital operations nationwide. The program specifically targets certain hospital-acquired infections, such as central line-associated bloodstream infections (CLABSIs), and can result in financial penalties for hospitals with elevated rates. Additionally, complications that are not solely related to CVC use, such as iatrogenic pneumothorax and deep venous thrombosis, are included in the quality metrics that hospitals must report. 1 In their systematic review and meta-analysis in JAMA Internal Medicine, Teja et al 2 investigated 15 CVC-related complications. The study found significant rates of placement failure, arterial puncture, pneumothorax, catheter malfunction, infections, and thrombosis. Notably, 3% of patients with a CVC for 3 days experienced serious complications, such as arterial cannulation, pneumothorax, infection, or deep vein thrombosis. A smaller percentage of these complications was tracked by the Hospital Inpatient Quality Reporting Program. The infection rates were similar for subclavian and femoral insertions, with a slightly higher rate observed for internal jugular insertions, although the confidence intervals overlapped, suggesting no significant difference. Arterial puncture and placement failure rates were similar across all CVC insertion sites, and the subclavian site had a significantly higher risk of pneumothorax than the internal jugular site did. The authors underscored the effectiveness of ultrasonography guidance in reducing complications such as arterial puncture, pneumothorax, deep venous thrombosis, and infections. 2 As new research and changing practices emerge, the traditional reliance on CVCs for various clinical applications is being reevaluated. Studies suggest that peripheral administration of vasopressors for patients with septic or cardiogenic shock, among others, is feasible and safe. 3 International surveys indicate a trend toward peripheral administration of medications such as norepinephrine, which is traditionally administered centrally due to its vesicant nature and risk of extravasation. Advances in parenteral nutrition and chemotherapeutic agent formulations have made peripheral administration more viable, further reducing the need for CVC placement. Recent developments in medical technology have led
