Central vein catheter and its care
What is a vein?
A vein is a type of blood vessel that returns blood from the tissues back to the heart; it has impure blood that contains less of oxygen and more of carbon dioxide and this blood needs to be pumped by the heart to lungs for purification (correction of oxygen and carbon dioxide content of impure blood to normal levels).
What is a central vein?
A central vein is a large vein that empties out in or near the heart; from here, blood can reach heart within a very short time; as several veins join together to form central vein, there will be greater blood flow in these veins.
In comparison, the veins in the limbs (peripheral veins) are “far away” from the heart and blood may take longer time to reach the heart; they are small and carry less amount of blood.
What is a blood line or catheter?
A blood line or catheter is a tube that has one of its ends within the blood vessel and the other end, on the skin surface. We need these blood lines to have approach to the circulation to give medicines or fluids to the body.
What is a central venous catheter?
A central venous catheter, also known as a central line, is a long, flexible tube that doctors place in a large vein in the neck (jugular vein), chest (subclavian vein) or thigh (femoral vein).
What are the advantages of central vein catheter over a standard intravenous (IV) line?
A central venous catheter can be used to give fluids, blood or medications quickly as it empties out in or near the heart. Blood if properly collected through central veins can be used to do medical tests. Central lines can also be used to measure the pressure within the heart and for doing hemodialysis. It can remain for weeks or months (if it is tunneled; see below). Central venous catheters are important in treating many conditions, particularly in intensive care units (ICU).
Standard IV line can only be used for administration of fluids, blood, or medications; it may not be as beneficial as the central line in an emergency as fluids, blood or medications cannot be given quickly through this line. It cannot be used for sample collection for blood testing, venous pressure monitoring or dialysis. Standard IV line cannot be maintained beyond a few days in its location.
What types of central venous catheters do you use in your hospital?
There are several types of central venous catheters. We use the type that is best for each patient’s case. Central vein catheters with small lumen are used if there is no need for dialysis and the purpose of the catheter is only to administer fluids and medications or to measure central venous pressure or to collect blood samples. Catheters used for dialysis have larger lumens; they can also be used for all the above-mentioned purposes. Apart from these standard catheters, special catheters called tunneled catheters (discussed below) are also available.
Where do you perform these procedures?
Standard catheters are inserted into a large vein in the neck, chest or thigh by a trained medical professional in ICU or Operating Room (OR).
Will the insertion be painful?
The insertion will be done under local anaesthesia; local anaesthetic cream will be applied over the area of insertion an hour before the procedure. This cream will minimize pain over the skin. A local anaesthetic injection will also be given into the tissues under the skin just before insertion of the catheter. This will minimize pain while putting the catheter beneath the skin.
Will there be complications during the insertion procedure?
The insertion procedure can be associated with the risk of injury to other blood vessels or nerves lying close to the central vein or very rarely, injury to the lung or heart; there can be temporary disturbances in heart rhythm during the procedure. Considering these risks, it is performed under cardiac monitoring. Sometimes, it can result in local blood leak or swelling; the swelling will subside on its own over a period of time.
What are the other complications of central vein catheters?
The other complications related to central vein catheter are clotting in the blood vessel into which the catheter is inserted (this can result in swelling and sometimes pain in the area affected) and infection resulting in fever and/or pain and discharge at the site of catheter insertion. Longer the catheters are in place, greater will be the risk of these complications.
How can I avoid these complications?
Central vein catheters should be removed as early as possible if there is no further requirement for the same. It will be required for a longer period in patients with chronic kidney disease (CKD) who require dialysis. Patients with CKD should undergo a surgical procedure called arteriovenous (AV) fistula in one of their upper limbs as early as possible. Once AV fistula is mature, dialysis can be continued through AV fistula and central vein catheter can be removed. Hand hygiene during handling of central vein catheter will go a long way in minimizing the risk of central vein catheter related infection.
What about tunneled catheters?
Standard catheters will be inserted directly into the large vein soon after skin prick. Tunneled catheters are much longer and run under the skin for a short distance (10-15cm) before their entry into central veins. The creation of this subcutaneous tunnel requires surgical skill, fluoroscopic guidance (continuous x ray monitoring) and higher level of anaesthesia and they are placed in the OR under sedation. Therefore they are relatively more expensive.
Are tunneled catheters advantageous?
Yes; they can be retained for longer periods of time (several months) and in case of catheter related infection, an attempt can be made to treat the infection with antibiotic before considering removal of the catheter (any episode of fever in a patient having a central vein catheter is likely to be related to the catheter itself if there is no other source of infection; in such situations, a standard catheter will have to be removed).
How can I take care of my catheter?
- Keep asking your doctors and nurses to explain why you need the catheter and how long you will have it
- Make sure that all doctors and nurses caring for you clean their hands with an alcohol-based hand rub before and after caring for you. If you do not see your health care providers cleaning their hands, please ask them to do so
- If the catheter dressing comes off or becomes wet or dirty, tell your nurse or doctor immediately
- Inform your nurse or doctor if the area around your catheter is sore or red
- Do not let family and friends who visit you touch the catheter or the tubing
- Make sure family and friends clean their hands with soap and water or an alcohol-based hand rub before and after visiting you in case they are getting into contact with you
Do I need to know anything more about the catheter?
Yes, please go through the Public Information Brochure on Central Line Associated Blood Stream Infection for details on prevention and management of infection in relation to central vein catheter.