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. 💉🩸
Here’s our summary of CVCs:
👉🏼 Internal jugular vein (side of the neck)
👉🏼 Subclavian vein (under the collarbone)
👉🏼 Femoral vein (the groin)
👉🏼 Check out our CS article on indications 😜
👉🏼 Central lines are inserted using the “Seldinger” technique:
1️⃣ Find the vein by venous flashback in the needle
2️⃣Thread a wire through and remove the needle
3️⃣ Insert the catheter over the wire.
👉🏼 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.
👉🏼 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.
👉🏼 To optimise venous filling (and therefore safety), the patient is often tilted head down for internal jugular and subclavian insertion.
👉🏼 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.
👉🏼 The tip of internal jugular and subclavian vein CVCs should be sitting in the superior vena cava (SVC).
👉🏼 Methods to confirm position include
🔺Ultrasound to check wire (wire is in correct vein)
🔺Venous pressure waveform (tip is in a vein)
🔺Chest X-ray (tip is in the SVC)
When should they be removed?
👉🏼 This depends on the setting, indication and treating team.
👉🏼 In general, a CVC should be safely removed when:
🔺It is no longer required
🔺There are signs of infection
🔺There is suspicion of line-related infection
Keep an eye out for our other concept series articles on setup, indications and complications of CVCs. 🙃
Ref: https://resources.wfsahq.org/atotw/central-venous-cannulation-anaesthesia-tutorial-of-the-week-138/
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