Central Venous Catheters

centralvenouscatheter cvc invasive device Apr 15, 2024
A central venous catheter (CVC) is 5-20cm, multi-lumen cannula that is placed into a central vein. Although there are various types, including peripherally inserted catheters, long term ports and dialysis catheters, this article will refer to the multi-lumen short term devices we often insert for surgical patients. ๐Ÿ’‰๐Ÿฉธ
 
Here’s our summary of CVCs:
 
Where do we put them?
๐Ÿ‘‰๐Ÿผ Internal jugular vein (side of the neck)
๐Ÿ‘‰๐Ÿผ Subclavian vein (under the collarbone)
๐Ÿ‘‰๐Ÿผ Femoral vein (the groin)
 
Which patients need one?
๐Ÿ‘‰๐Ÿผ Check out our CS article on indications ๐Ÿ˜œ
 
How are they inserted?
๐Ÿ‘‰๐Ÿผ Central lines are inserted using the “Seldinger” technique:
1๏ธโƒฃ Find the vein by venous flashback in the needle
2๏ธโƒฃThread a wire through and remove the needle
3๏ธโƒฃ Insert the catheter over the wire.
๐Ÿ‘‰๐Ÿผ As the catheter is 2-3mm (external) diameter, the tissues need dilating prior to insertion of the catheter. The dilator is inserted over the wire, and some patients will need a small cut with a scalpel.
๐Ÿ‘‰๐Ÿผ Real-time ultrasound guidance is now the gold standard, so you will most likely need a high-frequency, linear probe with a sterile probe cover.
๐Ÿ‘‰๐Ÿผ To optimise venous filling (and therefore safety), the patient is often tilted head down for internal jugular and subclavian insertion.
๐Ÿ‘‰๐Ÿผ The needle and wire are safely discarded and the device is sutured to the skin and dressed. Each lumen is aspirated and flushed with normal saline.
๐Ÿ‘‰๐Ÿผ The tip of internal jugular and subclavian vein CVCs should be sitting in the superior vena cava (SVC).
๐Ÿ‘‰๐Ÿผ Methods to confirm position include
๐Ÿ”บUltrasound to check wire (wire is in correct vein)
๐Ÿ”บVenous pressure waveform (tip is in a vein)
๐Ÿ”บChest X-ray (tip is in the SVC)
 
When should they be removed?
๐Ÿ‘‰๐Ÿผ This depends on the setting, indication and treating team.
๐Ÿ‘‰๐Ÿผ In general, a CVC should be safely removed when:
๐Ÿ”บIt is no longer required
๐Ÿ”บThere are signs of infection
๐Ÿ”บThere is suspicion of line-related infection
 
Keep an eye out for our other concept series articles on setup, indications and complications of CVCs. ๐Ÿ™ƒ
 
Build knowledge โœ…
Improve safety โœ…
 
Ref: https://resources.wfsahq.org/atotw/central-venous-cannulation-anaesthesia-tutorial-of-the-week-138/
 

 

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