Central Venous Catheterization: An Overview

Central Venous Catheterization: An Overview

Central venous catheters (CVCs) play an important role in delivering medications and fluids in many hospitalized patients who need intravenous access. However, central lines also carry risks that must be carefully managed by healthcare providers. This article aims to provide an overview of CVCs, including the types, insertion process, care, and potential complications.

Types of CVCs

There are different types of CVCs commonly used depending on the clinical need and anatomical location being accessed.

Peripherally Inserted Central Catheters (PICCs)

PICCs are relatively thin catheters inserted through the arm into a vein close to the heart. They can remain in place for weeks or months in outpatients who require long-term intravenous therapy. PICCs have lower risk of complications than other Central Venous Catheters due to their peripherally placed tip location.

Tunnelled CVCs

Tunnelled CVCs like Hickman and Broviac lines have cuffs that hold the catheter in place under the skin. The catheter segment passes through a tunnel just beneath the skin before entering the vein. This protects the entry site and allows the catheter to remain safely in place for months during treatments like chemotherapy.

Nontunneled CVCs

Nontunneled CVCs like internal jugular or subclavian catheters have short segments that pass directly from the skin into the vein without tunnelling under the skin. They are usually meant for temporary use of up to several weeks.

Insertion of CVCs

Central lines are generally inserted by interventional radiologists, cardiac surgeons or specially trained nurses/physicians. Standard steps for insertion include:

1) Preparing the insertion site with antiseptic and anesthesia.

2) Making a small puncture through the skin and using ultrasound guidance to access the desired vein.

3) Passing the CVC into position, checking tip location with an X-ray.

4) Securing the catheter to the skin with sutures or sterile dressings and verifying proper function.

5) Applying sterile dressing to the insertion site and connecting extension tubing for ongoing use.

Care and Maintenance

After insertion, CVCs require meticulous care and cleaning to prevent infections:

- Hand hygiene must be followed before any contact with the catheter or site.

- Dressings are routinely inspected and changed if soiled to prevent pathogens from entering.

- Daily patency checks involve slowly flushing sterile saline and aspirating blood to ensure the line hasn't clotted.

- Strict protocols are followed for administering or changing any infusions/ medications through the line.

Potential Complications

While CVCs are life-saving for many patients, there are risks to be aware of:

- Infection is a major concern if sterile technique is breached during insertion or maintenance. Signs include fever, redness or drainage around the insertion site.

- Thrombosis or clotting within the catheter can obstruct flow and require pharmacologic or mechanical therapy to restore patency.

- Air embolism is a risk if positive pressure is applied incorrectly during flushing. Symptoms include chest pain and difficulty breathing.

- Bleeding complications can occur if the catheter punctures through the vein or compromises another nearby structure during insertion.

- Arrhythmias are possible if the catheter tip rests in the heart during insertion, potentially causing cardiac irritation.

- Catheter embolization or breakage with fragments potentially lodging in the heart or lungs would require emergency removal if detected on imaging.

 CVCs serve critical care needs but also require skill and diligence to manage risks. Following proper technique during insertion and meeting strict infection control protocols for ongoing maintenance can help minimize life-threatening complications and optimize patient safety with these indispensable medical devices. With appropriate care, CVCs improve quality of life for many patients dependent on long-term IV therapy.
 
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