Central venous catheter
Citation, DOI & article data
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.
- 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. Port-a-Cath, Infus-a-Port
- may be located in the chest or arm (brachial)
- may be single or dual lumen
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)
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.
- 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
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- 2. Funaki B. Chest port insertion. Semin Intervent Radiol. 2005;22 (03): 242-4. doi:10.1055/s-2005-921958 - Free text at pubmed - Pubmed citation
- Saugel B, Scheeren T, Teboul J. Ultrasound-Guided Central Venous Catheter Placement: A Structured Review and Recommendations for Clinical Practice. Crit Care. 2017;21(1):225. doi:10.1186/s13054-017-1814-y - Pubmed