Central venous catheters, commonly referred to as CVCs, are life-saving medical devices that allow doctors to deliver fluids, medication, chemotherapy drugs and blood products directly into a large vein near the heart. However, many people remain unaware of what CVCs are, how they work and their associated risks..
What is a Central Venous Catheter?
A Central Venous Catheters is a thin, flexible tube placed into a large vein in the neck, chest or groin to deliver fluids or medication. CVCs have several parts including an inner catheter, an outer catheter known as the introducer sheath and a small disc or loop that sits just under the skin after insertion to secure the catheter in place. CVCs come in various types depending on where they are placed and how long they need to remain inserted. Some common CVC types include:
- Peripherally Inserted Central Catheter (PICC): Placed in an arm vein and threaded into a large chest vein, PICCs are often used when IV treatments are needed for weeks or months.
- Tunnelled Catheter: Similar to a PICC but inserted in the neck or chest and tunnelled under the skin to the insertion site to reduce infection risk.
- Non-Tunnelled Catheter: Directly inserted into the neck, chest or groin vein and used short term for a few days.
- Implanted Port: A small reservoir placed entirely under the skin in the chest connected to a catheter in a large vein, ports last years and have the lowest infection risk.
Why are CVCs Used?
CVCs enable doctors to deliver fluids or medications that would otherwise be too harsh or impractical to administer through a regular IV in the arm or hand. Some common reasons CVCs are used include:
- Long-term IV antibiotics: Used to treat severe infections when weekly IV doses are needed over several months.
- chemotherapy: Many chemo drugs are too harsh for peripheral veins and require direct delivery into larger central veins.
- Parenteral nutrition: A liquid form of nutrients given through an IV is delivered via CVC for patients who cannot eat.
- Blood products: Transfusions of blood, platelets or plasma are often given through a CVC as they require central venous access.
Risks of Central Venous Catheters
While CVCs are crucial for many patients, they do carry some risks, the most serious being infection and thrombosis or blood clots. Some potential complications include:
- Catheter-related bloodstream infection (CRBSI): Bacteria can enter through the catheter insertion site and spread into the bloodstream causing fever, chills and sepsis. This is the most common CVC complication.
- Thrombus formation: Blood clots can form on the catheter or within the vein, potentially leading to pulmonary embolism if a clot dislodges and lodges in the lung.
- Air embolism: Air entering the catheter during flushing can form an air bubble in the heart or block blood flow.
- Bleeding: There is a risk of bleeding from the insertion site or puncture of other structures like the lung during placement.
- Arrhythmia: In rare cases, the tip of the catheter may irritate the heart and disrupt its electrical signals.
- Catheter embolism: A piece of the catheter breaks off in the vein, which then must be surgically removed.
Proper CVC Care is Key
To reduce risks, CVCs must be inserted and cared for using strict sterile technique following evidence-based protocols. Some important best practices include:
- Using the smallest catheter possible for the intended use and removing it as soon as no longer needed.
- Performing careful hand hygiene and using full barrier precautions like masks, gloves and sterile drapes during dressing changes and injections.
- Cleaning the insertion site with chlorhexidine antiseptic before and after accessing the catheter.
- Flushing the catheter regularly with heparin or saline to prevent clotting and maintain patency.
- Checking for signs of infection like fever and inspecting the insertion site daily.
- Considering an antimicrobial or antiseptic impregnated cuff or catheter when infection risk is high.
- Obtaining blood cultures and removing the catheter promptly if an infection is suspected.
Central venous catheters are an invaluable medical technology when used properly. By understanding their functions, potential risks and best practices for care, patients can better partner with providers to ensure safe and optimal CVC usage. Further research continues to help maximize these life-extending devices' benefits while minimizing avoidable harm.
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