Central venous catheter

Central venous catheters (CVC), also known as central venous lines (CVL), refer to a wide range of catheters that are inserted so that their distal tips lie in a central vein. Central venous access devices can broadly be divided into four categories. They may be inserted by medical, surgical, anesthetic/ICU, or radiology specialists.

Classification

• peripherally inserted central catheters (PICC)
• non-tunneled CVCs
  • e.g. used in ICU or ED for emergent or short-term (<7-10 days) access
  • e.g. Vascath used for haemodialysis, apheresis, stem cell collection, etc.
• tunneled CVCs
  • e.g. Hickman catheters, Groshong catheter, Broviac line, Permcath
• implantable ports
  • e.g. Port-a-Cath, Infus-a-Port
  • may be located in the chest or arm (brachial)
  • may be single or dual lumen

Site

Central venous catheters can be inserted into a variety of veins, most commonly including:

• internal jugular vein (see: jugular venous catheters)
• subclavian vein
• femoral vein (typically only short-term access)
• brachial, basilic or cephalic veins (for PICCs and implantable ports)

Placement

Policy varies by institution but tip placement for neck/thoracic/upper limb CVCs in the superior vena cava or at the cavoatrial junction is generally acceptable. There is a limited differential of left paramediastinal catheter positions.

Ultrasound-guided CVL insertion is proposed to reduce the number of complications and to increase the safety and quality of central venous catheter (CVC) placement.

Complications  

• pneumothorax
• hemothorax
• infusothorax
• arrhythmia
• infection
• mediastinal hematoma
• arterial placement
• perforation of vein needing a stent
• pinch off syndrome
• retained guidewire
• guidewire shearing and fragment embolization
• sheared fragment of catheter
• malposition of port and or tip
• azygos termination
• retained hub
• downhill esophageal varices