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. ๐๐ฉธ
Here’s our summary of CVCs:
๐๐ผ Internal jugular vein (side of the neck)
๐๐ผ Subclavian vein (under the collarbone)
๐๐ผ Femoral vein (the groin)
๐๐ผ Check out our CS article on indications ๐
๐๐ผ Central lines are inserted using the “Seldinger” technique:
1๏ธโฃ Find the vein by venous flashback in the needle
2๏ธโฃThread a wire through and remove the needle
3๏ธโฃ Insert the catheter over the wire.
๐๐ผ 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.
๐๐ผ 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.
๐๐ผ To optimise venous filling (and therefore safety), the patient is often tilted head down for internal jugular and subclavian insertion.
๐๐ผ 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.
๐๐ผ The tip of internal jugular and subclavian vein CVCs should be sitting in the superior vena cava (SVC).
๐๐ผ Methods to confirm position include
๐บUltrasound to check wire (wire is in correct vein)
๐บVenous pressure waveform (tip is in a vein)
๐บChest X-ray (tip is in the SVC)
When should they be removed?
๐๐ผ This depends on the setting, indication and treating team.
๐๐ผ In general, a CVC should be safely removed when:
๐บIt is no longer required
๐บThere are signs of infection
๐บThere is suspicion of line-related infection
Keep an eye out for our other concept series articles on setup, indications and complications of CVCs. ๐
Ref: https://resources.wfsahq.org/atotw/central-venous-cannulation-anaesthesia-tutorial-of-the-week-138/
Stay connected with news and updates!
Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.
We hate SPAM. We will never sell your information, for any reason.