In medicine, a central venous catheter (CVC or central (venous) line) is a catheter placed into a large vein in the neck, chest, or groin. Most commonly used veins are the internal jugular vein, the subclavian vein and the femoral vein. This is in contrast to a peripheral line which is usually placed in the arms or hands. The Seldinger technique is generally employed to gain central venous access.

Description

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Dependent on its use, the catheter is monoluminal, biluminal or triluminal, dependent on the actual number of tubes or lumens (1, 2 and 3 respectively). Some catheters have 4 or 5 lumens.

The catheter is usually held in place by a suture and an occlusive plaster or dressing. Regular flushing with saline or a heparin-containing solution keeps the line patent and prevents infection.

Indications and uses

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Indications for the use of central lines include:

• Monitoring of the central venous pressure (CVP) in acutely ill patients to quantify fluid balance
• Parenteral nutrition
• Drugs that are prone to cause phlebitis in peripheral veins (caustic), such as:
  • Calcium gluconate
  • Chemotherapy
  • Potassium chloride
  • Amiodarone
• Need for intravenous therapy when peripheral venous access is impossible
  • Blood
  • Medication
  • Rehydration

Central venous catheters usually remain in place for a longer period of time, especially when the reason for their use is longstanding (such as total parenteral nutrition in a chronically ill patient). For such indications, a Hickman line, a PICC line or a portacath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a porte d'entrée (place of entry) for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci.

Complications

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Potential complications include:

• Pneumothorax (for central lines placed in the chest) - this is why doctors routinely order a chest X-ray after insertion of a subclavian or internal jugular line.
• Sepsis. All catheters can introduce bacteria into the bloodstream, but CVCs are known for occasionally causing Staphylococcus aureus and Staphylococcus epidermidis sepsis. A patient with a central line, fever, and no obvious cause of the fever may have catheter-related sepsis. Generally, antibiotics are used, and occasionally the catheter will have to be removed. To prevent infection, some central lines are now coated or impregnnated with antibiotics or silver (specifically silver sulfadiazine).
• Air embolism
• Haemorrhage
• Arrhythmia

External links

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• Photo galleries of central line placement showing the procedure step-by-step with and without ultrasound guidance. Clinical Notes.

• Complications of central line placement. Clinical Cases and Images.

Medical equipment

Zentraler Venenkatheter | Wkłucie centralne | Central venkateter | 中心靜脈導管