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. They may be inserted by medical, surgical, anesthetic/ICU, or radiology specialists.
On this page:
Types
Central venous access devices can broadly be divided into four categories:
-
non-tunneled CVCs
e.g. used in ICU or ED for emergent or short-term (<7-10 days) access
e.g. Vascath is used for hemodialysis, apheresis, stem cell collection, etc.
-
tunneled CVCs
e.g. Hickman catheters, Groshong catheter, Broviac line, Permcath
-
e.g. Port-a-Cath, Infuse-a-port
may be located in the chest or arm (brachial)
may be a single or dual lumen
Site
Central venous catheters can be inserted into a variety of veins, most commonly including:
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 CVC insertion is proposed to reduce the number of complications and to increase the safety and quality of central venous catheter (CVC) placement.
Complications
infection
perforation of vein needing a stent
Intravenous contrast injection
Contrast media injection through a central venous catheter is safe with complication rate of 1% if a strict protocol is followed. Among the complications are 4:
catheter rupture leading to contrast extravasation
loss of vascular access
embolization of catheter fragments
catheter obstruction
mediastinal contrast extravasation
Catheters more than 3 months old have increased risk of rupture. Automatic power injection or hand injection of contrast media poses the same risk of catheter rupture 4.
Safety protocols when using CVC as intravenous contrast injection site are 5:
aspirating blood before the injection of contrast media
localizing the position of CVC before and after the injection
ensuring no kinking of the CVC
using sterile syringes
making sure CVC is patent after scanning
Slow injection rates of 2 mL/s only minimally compromises the image quality. Meanwhile, higher flow rates have increased risk of catheter rupture with uncertain guarantee of image quality 4,5.
Unable to process the form. Check for errors and try again.