April 13, 2024
Central Venous Catheters

Central Venous Catheters: Lifelines in Critical Care Management

A central venous catheter, also known as a central line, is a long, thin, flexible tube that is placed in a large vein near the heart. Central lines are commonly used in hospitals to give medicines or fluids, such as saline, antibiotics, chemotherapy drugs or blood transfusions. They are also used to measure central venous pressure and to draw blood.

Types of Central Venous Catheters
There are different types of Central Venous Catheters used for various purposes:

Non-Tunnelled Catheters: These catheters are short-term catheters meant to stay in place for a few days. They are inserted directly into the vein without tunnelling under the skin. Non-tunnelled catheters are commonly used in hospital settings for a few weeks or less.

Tunnelled Catheters: These catheters have part of the catheter tunneled under the skin to prevent infection. They can stay safely in place for several months. Tunnelled catheters are used when intravenous access is needed for a longer period of time, usually a few months.

Implanted Ports: An implanted port or port-a-cath is a small disc-shaped device placed just under the skin of the chest. It has a silicone catheter attached to it that is inserted into a large vein leading to the heart. The port-a-cath is entirely under the skin and is accessed through the skin using a non-coring needle. It can stay in place for many years to provide repeated access to the bloodstream.

Insertion Procedure
Central lines are placed in one of the major central veins – the internal jugular vein, subclavian vein or femoral vein. The procedure involves:

– Applying local anesthesia to numb the skin at the insertion site.

– The doctor then uses ultrasound guidance to visualize the vein and guide the catheter into place.

– After inserting the catheter tip into the selected vein, the catheter is fed through the vein into the superior vena cava, the large vein leading to the heart.

– The catheter is then secured to the skin with sutures to prevent movement and infection.

– Dressings are applied after the procedure to protect the site.

Risks and Complications
While central lines are very useful in many medical situations, they also carry certain risks if not managed properly:

– Infection: Improper cleaning or dressing of catheter site can lead to local or bloodstream infections.

– Blood clots: Catheters can damage the inner lining of veins, causing blood clots to form (thrombosis). Clots can dislodge and travel to the lungs (pulmonary embolism), which can be life-threatening.

– Air embolism: Air accidentally entering the catheter during procedures can form air bubbles in blood vessels. Large bubbles can block blood flow to organs and cause cardiac arrest.

– Catheter misplacement: Rarely, the catheter may get accidentally placed into an artery instead of a vein or pierce through the vein wall into the chest or neck.

– Bleeding: Puncture of a blood vessel during insertion can lead to internal or external bleeding, which may need blood transfusions.

– Pneumothorax: Inserting catheters through the chest cavity carries a small risk of puncturing and collapsing a lung.

Proper Care and Maintenance
Strict sterility and proper care is needed to minimize risks of central lines:

– Handwashing is essential before and after any contact with catheter site.

– Dressings around insertion site must be kept dry and clean. They should only be changed if soiled or dirty to prevent infections.

– Daily assessment of insertion site for signs of inflammation, redness or bleeding. Any issues require immediate medical attention.

– Regular flushing of catheter lumens with saline to prevent blood clots as per doctor’s orders.

– Antibiotic cream may be applied around insertion site as prescribed to reduce infection risk.

– Catheters should be secured tightly to skin to prevent dislodging but not too tight to cause injury.

– No unnecessary traction or pulling on catheter as it can damage or dislodge it.

– Strict sterility must be followed by all healthcare providers when accessing catheter lumens or changing dressings and tubing.

– Prompt removal of catheter as soon as it is no longer needed to reduce infection risks.

Central venous catheters serve an important role in delivering critical medicines and fluids as well as monitoring a patient’s cardiovascular status. However, they carry risks like any foreign body. With attention to sterile technique during insertion and maintenance, as well as prompt removal when no longer needed, central lines can provide effective long-term venous access with minimal complications. Adherence to protocols for regular care and dressing changes is key to early detection and treatment of any issues.

1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it