Central venous catheter
Updates to Article Attributes
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, anaesthetic/ICU, or radiology specialists.
Classification
-
non-tunnelled CVCs
e.g. used in ICU or ED for emergent or short-term (<7-10 days) access
e.g. Vascath is used for haemodialysis, aphaeresis, stem cell collection, etc.
-
tunnelled CVCs
e.g. Hickman catheters, Groshong catheter, Broviac line, Permcath
-
e.g. Port-a-Cath, Infus-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 CVL insertion is proposed to reduce the number of complications and to increase the safety and quality of central venous catheter (CVC) placement.
Complications
arrhythmia
infection
perforation of vein needing a stent
Intravenous contrast injection
Contrast 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
embolisation of catheter fragments
catheter obstruction
mediastinal contrast extravasation
mediastinal haematoma
cardiac arrhythmia.
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
localising the 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 rate of 2ml s-1 only minimally compromise the image quality. Meanwhile, high flow rates have higher risk of catheter rupture with uncertain gurantee of image quality 4,5.
-</ul>- +</ul><h4>Intravenous contrast injection</h4><p>Contrast injection through a central venous catheter is safe with complication rate of 1% if a strict protocol is followed. Among the complications are <sup>4</sup>:</p><ul>
- +<li><p>catheter rupture leading to contrast extravasation</p></li>
- +<li><p>loss of vascular access</p></li>
- +<li><p>embolisation of catheter fragments</p></li>
- +<li><p>catheter obstruction</p></li>
- +<li><p>mediastinal contrast extravasation</p></li>
- +<li><p>mediastinal haematoma</p></li>
- +<li><p>cardiac arrhythmia.</p></li>
- +</ul><p>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 <sup>4</sup>.</p><p>Safety protocols when using CVC as intravenous contrast injection site are <sup>5</sup>:</p><ul>
- +<li><p>aspirating blood before the injection of contrast media</p></li>
- +<li><p>localising the the position of CVC before and after the injection</p></li>
- +<li><p>ensuring no kinking of the CVC</p></li>
- +<li><p>using sterile syringes</p></li>
- +<li><p>making sure CVC is patent after scanning</p></li>
- +</ul><p>Slow injection rate of 2ml s<sup>-1</sup> only minimally compromise the image quality. Meanwhile, high flow rates have higher risk of catheter rupture with uncertain gurantee of image quality <sup>4,5</sup>.</p><p></p><p></p>
References changed:
- 4. Plumb A & Murphy G. The Use of Central Venous Catheters for Intravenous Contrast Injection for CT Examinations. BJR. 2011;84(999):197-203. <a href="https://doi.org/10.1259/bjr/26062221">doi:10.1259/bjr/26062221</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21325362">Pubmed</a>
- 5. Buijs S, Barentsz M, Smits M, Gratama J, Spronk P. Systematic Review of the Safety and Efficacy of Contrast Injection via Venous Catheters for Contrast-Enhanced Computed Tomography. European Journal of Radiology Open. 2017;4:118-22. <a href="https://doi.org/10.1016/j.ejro.2017.09.002">doi:10.1016/j.ejro.2017.09.002</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29034281">Pubmed</a>
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