A venous catheter, also known as central line is a device that is incorporated inside the vein of the central vasculature until it reaches close to the heart. It differs from an IV line in the context that it grants a bigger cannula so as to offer more options as compared to the previous. It’s usage has increased partly due to outpatients, inpatient and community settings so as to offer long-term access to venous vasculature.
What are the indications for use?
- Administration of blood products and intravenous fluids.
- Immediate medication delivery in an unstable patient.
- Administration of hypertonic solutions and solutions with abnormal pH values for example vancomycin.
- Acquiring blood samples of the venous system.
- Offers a long duration of intravenous therapy.
- Quickly delivers volumes of intravenous fluid.
- Administering vasodilator/vasopressor therapy such as dopamine.
- Monitoring of central venous pressure.
- Makes it possible to access the trans-venous pacemaker or pulmonary artery catheter.
- Gives hemodialysis access.
Read our guide on how to insert a central venous line.
What are contraindications?
- Venous stenosis.
- Occluded vein.
- Respiratory problems with excess FiO2
- Infected site.
- Elevated ICP (IJ line).
- Scorched sites.
- Site with trauma for example clavicle fracture.
What are the various types?
- Implanted Venous Access Device. (long-term)
- PICC (peripherally inserted central catheters). (long-term)
- Tunneled Catheters (long term)
- Short-term (Percutaneous, Non-tunneled, No-Cuffed)
Short-term central catheters
This is also known as percutaneous, non-tunneled or percutaneous sheath catheters. Short-term catheters are placed by piercing directly via the skin to the destination without necessarily passing via the subcutaneous tissue. Site insertion is typically located in the internal jugular or subclavian vein, however, it may be placed within the femoral vein. It is always recommendable to consider long-term catheters if it will be needed for more than two weeks. Due to high risk of infection, arterial cannulation and thrombosis femoral site should be highly avoided. Femoral venous catheters installed under emergency state should be relocated to another site at a period of 48 hours of placing.
An important note, the percutaneous venous catheter should only be introduced in critical areas. Patients with non-tunneled catheters or the short term fit appropriately for admission at the sites excluding frequent medicine coverage.
Long-term central catheters
This type of venous catheter persists in situ form for months to several years. Examples include the following, Implantable Venous Access Device (IVADs), Peripherally Inserted Central Catheters (PICCs), Tunneled CVCs.
- Implantable Venous Access Device: It can also be identified as a port. This device is surgically inserted into a vessel, organ or even body cavity, It’s then joined to a reservoir which is positioned under the skin.
- Peripherally Inserted Central Catheters (PICCs): This is a device placed by a physician, RN who is highly trained and extremely competent. Specifically in branchial, basilica or cephalic veins of the upper arms.
- Tunneled CVCs: The contiguous end is subcutaneously tunneled through the subcutaneous from the site of placement and pushed out via the skin towards the exit site.
Comparisons of these catheters can be found at The Joint Commission’s website.
Hemodialysis catheters may be either short-term and temporal or permanent and tunneled. It may be only obtained by hemodialysis staff nurses. In states of emergency, qualified registered nurses who work in critical areas, fully equipped with knowledge and competency are permitted to obtain the hemodialysis catheters.
References
- Patty Hignell, RN, BSN, MN, ENC(C) Vascular Access Clinical Practice Committee Fraser Health Authority October 2016 – Version 8, Retrieved from http://www.fraserhealth.ca/media/2016-CentralVenousCatheters.pdf
