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CENTRAL VENOUS ACCESS

Central venous access is a procedure where the catheter or the central line (a thin, long flexible tube) is inserted through the arm or chest into the large vein. This is used to give medicines, fluids, nutrients, and other blood products for a long period of time. <

The advantage of central venous access is that it does not require any IV access sites or repeated injections in the future. The use of the catheter is safe and therefore it may be kept for a week, month or even a year. The central venous access is inserted at three sites namely internal jugular vein, sub-clavian vein and femoral vein.

Need for Venous Access

Intravenous medicines are given through a vein. A standard IV drip is inserted into a small vein in the arm for short-term and cannot be used for long-term purpose. One way of administering a long-term IV medication is by central venous access. Central venous access helps prevent clots and unnecessary damage caused by repeated punctures of injection. The venous access device is used for:

  • Chemotherapy
  • Blood transfusions
  • Delivers fluids and nutrition
  • Administration of antibiotics and other IV drugs
  • Numerous blood draws for diagnostic testing

Types of Catheters

There are three types of central venous access. They are:

  • Peripherally Inserted Central Catheter: A PICC is a line that enters one of the veins in the arm and passes to a central vein near the heart. A small length of the line is only visible at the arm.
  • Tunneled Catheter: A tunneled catheter is placed in a large vein in the neck. The catheter is tunneled under the skin on the chest, instead of it coming out of the skin at the neck region. In this way a distance is created and the catheter leaves the skin from a distance from where is entered. Thus there is a decrease in the chances of infection. 
  • Implanted Port: An implanted port is similar to a tunneled catheter but it is left entirely under the skin. It contains a small reservoir which can be filled with medicines. This reservoir slowly releases the drug into the bloodstream. Thus, the port is located under the skin and is easier to maintain and have a low risk of infection.

Indications

Indications for central venous access include the following:

  • Nutritional support
  • Hemodialysis
  • Pulmonary artery catheterization (treats acute myocardial infarction)
  • Delivering of caustic medications (vasopressors)
  • Volume resuscitation (acute blood loss)
  • Central venous pressure monitoring
  • Emergency venous access

Contraindications

Absolute and relative contraindications to central venous access are as follows:

  • Distorted local anatomy
  • Infection at insertion site
  • Bleeding disorder
  • Possible thrombolysis

Absolute and relative contraindications to subclavian approach are:

  • Trauma (injury of subclavian vessels)
  • Coagulopathy (impaired coagulation)
  • Chest-wall deformity
  • Chronic obstructive pulmonary disease (COPD)

Complications

Use of central venous access may develop possible complications like:

  • Bleeding
  • Infection
  • Blood clots
  • Collapsed lung (Pneumothorax)
  • Blocked line

Medical Attention

Medical care is required if central venous access when inserted and any of the following symptoms occurs:

  • Swelling of the arm
  • Shortness of breath or chest pain
  • Tenderness around the device
  • Redness in the upper arm
  • Fever
  • If central line place disturbed
  • Unexplained weight loss
  • Mood elevations

Home Care

The following are the home care measures for the catheter:>

  • Always wash hands before touching the central line
  • Always keep the exit dry to prevent infection
  • Always cover exit and central line with waterproof material
  • Fasten the central line to the body to prevent pulling or dangling
  • Avoid tight clothes that rub or pull the central line
  • Avoid crimping the central line
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