Central Line Catheter

A central venous catheter (CVC), also known as a central line, central venous line, or central venous access catheter, is a catheter placed into a large vein. Catheters can be placed in veins in the neck (internal jugular vein), chest (subclavian vein or axillary vein), groin (femoral vein), or through veins in the arms (also known as a PICC line, or peripherally inserted central catheters). It is used to administer medication or fluids that are unable to be taken by mouth or would harm a smaller peripheral vein, obtain blood tests (specifically the “central venous oxygen saturation”), and measure central venous pressure.

Medical uses:

Reasons for the use of central lines include:

• Long-term intravenous antibiotics
• Long-term parenteral nutrition, especially in chronically ill persons
• Long-term pain medications
• Chemotherapy
• Drugs that are prone to cause phlebitis in peripheral veins (caustic), such as:
  • Calcium chloride
  • Chemotherapy
  • Hypertonic saline
  • Potassium chloride (KCl)
  • Amiodarone
  • Vasopressors (for example, epinephrine, dopamine)
• Plasmapheresis
• Peripheral blood stem cell collections
• Dialysis
• Frequent blood draws
• Frequent or persistent requirement for intravenous access
• Need for intravenous therapy when peripheral venous access is impossible
  • Blood
  • Medication
  • Rehydration
• Monitoring of the central venous pressure (CVP) in acutely ill people to quantify fluid balance

Central venous catheters usually remain in place for a longer period than other venous access devices, especially when the reason for their use is longstanding (such as total parenteral nutrition in a chronically ill person). For such indications, a Hickman line, a PICC line, or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as an entry point for pathogenic organisms. Additionally, the line itself may become infected with bacteria such as Staphylococcus aureus and coagulase-negative Staphylococci

Complications

• Pneumothorax
• Bloodstream infections
• Thrombosis
• Misplacement

Types

Implanted port

A port is similar to a tunneled catheter but is left entirely under the skin. Medicines are injected through the skin into the catheter. Some implanted ports contain a small reservoir that can be refilled in the same way. After being filled, the reservoir slowly releases the medicine into the bloodstream. An implanted port is less obvious than a tunneled catheter and requires little daily care. It has less impact on a person’s activities than a PICC line or a tunneled catheter. Surgically implanted infusion ports are placed below the clavicle (infraclavicular fossa), with the catheter threaded into the heart (right atrium) through a large vein. Once implanted, the port is accessed via non-coring “Huber” needles inserted through the skin. The health care provider may need to use topical anesthetic before accessing the port. Ports can be used for medications, chemotherapy, and blood. As ports are located completely under the skin, they are easier to maintain and have a lower risk of infection than CVC or PICC catheters

PICC line

Non-tunneled & tunneled catheters