Clinical Pearls for the Care and Injection of a Central Venous Catheter

Clinical Pearls for the Care and Injection of a Central Venous Catheter

A central venous catheter (CVC) is a long, thin tube that is placed in a large vein, usually in the neck (internal jugular) or chest (right subclavian) to provide permanent access for long-term administration of fluids and medication. CVCs are commonly used for chemotherapy, hemodialysis, parenteral nutrition and other treatments that cannot be delivered safely through peripheral venous access.

The insertion of a CVC is an important skill for clinicians to master, but it can be associated with a number of complications. Complications can occur at the time of insertion or during the maintenance of the device. Infections at the site of insertion are the most common complication; these may include exit-, tunnel- or pocket infections, and bloodstream infection. A thrombotic event, such as an arterial puncture or thrombophlebitis, is less common but more serious.

These complications are often preventable by careful technique during the insertion of a CVC and following specific guidelines for the care of patients with a CVC. The objective of this article is to review the current literature regarding the insertion and management of CVCs with particular emphasis on clinical pearls to help improve patient outcomes.

Infections at the insertion site of a CVC are a major concern for both patients and their healthcare providers. Infections at the insertion site of CVCs are reported in 5 to 19 percent of adults who have a central line,5 while infectious and thrombotic complications at the catheter insertion site occur in 2 to 26 percent of adults with a central line.

A number of factors may contribute to these rates, including the type of catheter and its location in the body. For example, untunneled catheters appear to have the highest infection rates while totally implanted venous-access devices have the lowest.

It is also critical that healthcare workers pay close attention to the skin surrounding a catheter. For instance, if the bandage around the catheter comes off or is wet, healthcare workers should immediately take action. They should not let other people touch the tubing or catheter insertion site, either, and they should wash their hands before and after touching the area.

Finally, a health care provider should know when to stop inserting the catheter. For example, if the catheter enters the right atrium and causes ectopy on a telemetry monitor (spiked P waves with amplitudes greater than R or S wave peaks), the health care provider should stop advancing the wire.

A central venous catheter is a life-saving and essential medical device that can provide patients with safe, efficient and productive treatment. However, the insertion of a central venous catheter can be complicated by a number of issues, such as improper use of equipment or the inability to anticipate and prevent potential problems. This can result in adverse events that are both dangerous to the patient and expensive for healthcare systems to treat. Several studies suggest that improving adherence to standard operating procedures can significantly reduce the rate of these complications.