Central venous catheter

Overview

A central venous catheter, sometimes referred to as a central line or CVC, is a medical device used to assist in the administration of numerous treatments. It is made of a long, slender, flexible tube that goes through a vein in your body. The tube passes through one or more veins before its tip arrives at the vena cava, a large vein that empties into your heart.

The tip of your central venous catheter (CVC) is positioned within your vena cava. The other end is situated either just above or below the skin on your chest, typically positioned on the right side. When the end is located outside your skin, it’s referred to as a “hub,” making it visible and tactile. On the contrary, if the opposite end is placed beneath your skin, it’s called a “portal” or “reservoir.” Although less visible, you can still feel a small lump under your skin, roughly the size of a quarter. The hub or the reservoir, serves as the entry point for your treatment.

A Central Venous Catheter (CVC) allows your doctor to access your bloodstream more easily, reducing the need for frequent needle sticks. This is particularly beneficial for individuals requiring continuous medication, fluids, blood draws, or blood transfusions. CVCs are also advantageous for those in need of short-term or emergency medical care.

Reasons for undergoing the procedure

Central lines provide assistance to persons in a variety of medical circumstances, such as those requiring:

• Chemotherapy
• Having your blood drawn often
• Blood or platelet transfusions
• Vena cava filter placement
• Hemodialysis
• Long-term antibiotics
• In an emergency, fluids or blood (like hypovolemic shock)
• Nutrients given directly into their blood (If their gastrointestinal system is not functioning correctly)
• Having access to prescription drugs at home.

Additionally, during various medical testing, providers employ CVCs.

Type of central venous catheter

There are various types of central venous catheters. Among them are:

• Non-tunneled central venous catheter. Short-term vein access (less than two weeks) is suitable for this form of CVC. Your doctor will puncture a vein in your upper chest, groin, or neck using a needle. The superior vena cava is where your healthcare provider inserts the catheter tip.
• Tunneled central venous catheter. This kind is suitable for access periods longer than two weeks. The catheter is surgically inserted into a vein in your neck or chest by your healthcare practitioner. The catheter “tunnels” eight to ten centimeters beneath your skin before coming out through it in a different part of your chest. Your provider may use a brand name for a tunneled CVC.
• Peripherally inserted central catheter (PICC). PICC lines and non-tunneled CVCs are comparable. However, rather than using a vein in your neck or chest, your provider punctures a vein in your upper arm. The catheter is threaded by your healthcare practitioner via veins until it reaches your superior vena cava.
• Subcutaneous (implanted) port. A port is suitable for at least three months of extended use. This type does not emerge through your skin at all. Your healthcare provider surgically implants it, ensuring it remains entirely within your body. Your skin’s surface is really close to the hub (catheter access site). In order to reach the hub for your treatment, your physician may need to make a needle puncture in your skin. This kind of catheter may be referred to by your provider as a Port-a-Cath or an implantable venous port.

The type of Central Venous Catheter (CVC) you need will be determined by your doctor, taking into account factors such as the duration of catheter use and your specific medical requirements. There are three common access points for CVC placement:

• Internal jugular vein in your neck.
• Subclavian vein in your upper chest.
• Common femoral vein in your groin.

Additionally, for Peripherally Inserted Central Catheters (PICC lines), the basilic and cephalic veins in your arm are common access locations.

Each insertion site has its own advantages and disadvantages. Your doctor will carefully assess your needs and medical condition to choose the most suitable insertion site for you.

Risks

Infection is the primary complication of central venous catheters. This is known Catheter-Related Bloodstream Infection (CRBSI). It might happen during the implantation of a catheter or later in normal life. If the catheter’s hub is outside of your body, you run a higher chance of developing a CRBSI, particularly if your PICC or CVC line is not tunneled. More lumens in the CVC also increase the danger. There is less chance of infection for tunneled CVCs and ports.

Other issues that could arise with the implantation of a CVC include:

• Bleeding
• Arrhythmia (usually ventricular arrhythmia or bundle branch block)
• Artery or vein injury
• Trachea injury
• Pneumothorax or collapsed lung

The following complications could arise following your procedure:

• Stenosis or narrowed vein
• Delayed bleeding
• Thrombosis

The following are potential side effects of removing a central venous catheter:

• Air embolism, a blood vessel-blocking gas bubble
• Fracture of the catheter (when a piece breaks off inside your vein)
• Bleeding.

Before the procedure

Your healthcare provider will provide you with a detailed explanation of the procedure, outlining its benefits and potential drawbacks. They will encourage you to ask any questions you may have. Subsequently, your doctor will seek your consent to proceed with the surgery. However, it’s important to note that in certain emergency situations, a thorough discussion may not be possible.

Depending on the specific vein your doctor needs to access, they will guide you in positioning yourself correctly. This may involve lying flat on your back or assuming a slight angle where your legs and feet are elevated above your chest. Your doctor will also connect you to monitors to continuously monitor your vital signs during the procedure.

During the procedure

The procedure for obtaining a central venous catheter varies depending on the type you need. If you require a PICC line or a non-tunneled CVC, the process involves a percutaneous procedure. In this method, your doctor uses a needle puncture on your skin to access your vein and insert the catheter. Your healthcare provider will follow these steps:

1. Make sure the region of your skin where the needle will be inserted is clean.
2. Give you a sedative to help you relax and medication to numb the region so you won’t feel pain.
3. Stick a needle into your skin. Depending on the vein your provider selects, the position will change. It could be in your groin, upper chest, neck, or arm.
4. Carefully advance the wire in your vein by threading it through the needle.
5. Use a scalpel to slightly enlarge the needle puncture site.
6. Insert a dilator, a device, into the skin’s opening. This tool facilitates the opening and passage of your catheter via your vein.
7. Slide the dilator a little bit deeper into your soft tissue.
8. Take out the dilator and start inserting the catheter through the guidewire.
9. Insert the catheter tip into one or more veins and continue until it reaches the desired spot. Your vena cava, either above or below your heart, is where the tip will be.
10. Secure the catheter’s outside end to your skin with sewing, then cover and disinfect the affected region with a bandage.

During the procedure, your doctor may utilize ultrasonography technology for guidance. Whether it’s for port or tunneled CVC implantation, your doctor will access your vein using similar techniques. However, there may be some differences to expect.

Tunneled CVC

Surgery and a needle puncture are needed for the insertion of a tunneled CVC. To keep you comfortable, either local or general anesthetic will be administered.

The entrance and exit ports of your catheter are different, which is another significant variation. The original vein access point is where the catheter exits your body when using a non-tunneled CVC or PICC line. Your doctor selects a new location for the catheter to exit your chest when you have a tunneled CVC.

Between the vein access site and the place where it exits your body, the catheter travels beneath your skin like an underground subway.

Subcutaneous port

Ports are tunneled catheters as well; the only distinction is that the catheter remains inside your body. It’s all located beneath your skin. You will be given general anesthesia and require surgery in addition to a needle puncture.

Your chest will be lightly incised where your port will remain by your doctor. This location will be near the vein access point. Just beneath your skin, your doctor will make a tiny pocket of space in your tissue. The port will be inserted into the pocket and sewn firmly in place. Your doctor will stitch the incision closed and apply a bandage.

After the procedure

Your doctor will verify that the treatment was completed successfully. To make sure your CVC is positioned correctly and there are no issues, they will take a chest X-ray. When you are ready to go home, your doctor will let you know and will also offer you with instructions on what to do there.

Additionally, your doctor will advise you on how long to use your catheter and when to have it taken out. The duration varies according to the reason for the catheter and your medical requirements.

Outcome

Your doctor will provide instructions on how to care for your catheter at home, and it’s crucial to follow these guidelines diligently to minimize the risk of infection. It’s essential to keep the hub of your CVC and the surrounding area clean and sterile.

Additionally, you may need to schedule regular appointments with your doctor to have your CVC flushed. This helps prevent blood clots and blockages from forming