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Encyclopedia > Central venous catheter

In medicine, a central venous catheter (CVC or central venous line) is a catheter placed into a large vein in the neck, chest or groin, this is inserted by a physician when the patient needs more intensive cardiovascular monitoring, for assessment of fluid status, and for increased viability of intravenous drugs/fluids. The most commonly used veins are the internal jugular vein, the subclavian vein and the femoral vein. This is in contrast to a peripheral line which is usually placed in the arms or hands. The Seldinger technique is generally employed to gain central venous access. Medicine is the science and art of maintaining andor restoring human health through the study, diagnosis, and treatment of patients. ... Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity, duct or vessel. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... The jugular veins are veins that bring deoxygenated blood from the head back to the heart via the superior vena cava. ... The subclavian vein is a continuation of the axillary vein and runs from the outer border of the first rib to the medial border of anterior scalene muscle. ... Grays Fig. ... The Seldinger technique is a medical procedure to obtain safe access to blood vessels and other hollow organs. ...

Central line equipment
Central line equipment
Triple lumen in jugular vein

Contents

ImageMetadata File history File links Download high resolution version (1024x768, 120 KB) Clinical Cases and Images http://note3. ... ImageMetadata File history File links Download high resolution version (1024x768, 120 KB) Clinical Cases and Images http://note3. ... Image File history File links Metadata Size of this preview: 750 × 600 pixelsFull resolution (1280 × 1024 pixel, file size: 176 KB, MIME type: image/jpeg)A photo I took of my wifes triple-lumen after an operation in March 2007. ... Image File history File links Metadata Size of this preview: 750 × 600 pixelsFull resolution (1280 × 1024 pixel, file size: 176 KB, MIME type: image/jpeg)A photo I took of my wifes triple-lumen after an operation in March 2007. ...

Description

Dependent on its use, the catheter is monoluminal, biluminal or triluminal, dependent on the actual number of tubes or lumens (1, 2 and 3 respectively,). Some catheters have 4 or 5 lumens, depending on the reason for their use.


The catheter is usually held in place by a suture or staple and an occlusive dressing. Regular flushing with saline or a heparin-containing solution keeps the line patent and prevents infection. It has been suggested that suture material be merged into this article or section. ... Heparin, a highly sulfated glycosaminoglycan is widely used as an injectable anticoagulant and has the highest negative charge density of any known biological molecule. ...


Indications and uses

Indications for the use of central lines include:

Central venous catheters usually remain in place for a longer period of time, especially when the reason for their use is longstanding (such as total parenteral nutrition in a chronically ill patient). For such indications, a Hickman line, a PICC line or a portacath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a porte d'entrĂ©e (place of entry) for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. Central venous pressure (CVP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. ... Total parenteral nutrition (TPN), also called hyperalimentation, is the practice of feeding a person without using the gut. ... Phlebitis is an inflammation of a vein, usually in the legs. ... The chloride ion is formed when the element chlorine picks up one electron to form an anion (negatively-charged ion) Cl−. The salts of hydrochloric acid HCl contain chloride ions and can also be called chlorides. ... Chemotherapy is the use of chemical substances to treat disease. ... The chemical compound potassium chloride (KCl) is a metal halide composed of potassium and chlorine. ... Amiodarone belongs to a class of drugs called Vaughan-Williams Class III antiarrhythmic agent. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... This article does not cite any references or sources. ... Rehydration is the pissing of water and electrolytes lost through dehydration. ... Total parenteral nutrition (TPN), is the practice of feeding a person intravenously, circumventing the gut. ... A Hickman line in a leukemia patient. ... A peripherally inserted central catheter (PICC or PICC line) is a form of intravenous access that can be used for a prolonged period of time, e. ... Port-a-Cath device. ... Binomial name Rosenbach 1884 Staphylococcus aureus , (literally Golden Cluster Seed) the most common cause of staph infections, is a spherical bacterium, frequently living on the skin or in the nose of a person, that can cause a range of illnesses from minor skin infections (such as pimples, boils, and cellulitis...


Complications

Potential complications include:


Pneumothorax

Pneumothorax (for central lines placed in the chest) - this is why doctors routinely order a chest X-ray (CXR) after insertion of a subclavian or internal jugular line. The incidence is thought to be higher with subclavian vein catheterization. In catheterization of the internal jugular vein, the risk of pneumothorax can be minimized by the use of ultrasound guidance. For experienced clinicians, the incidence of pneumothorax is about 1%. Left-sided pneumothorax (on the right side of the image) on CT scan of the chest. ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... Ultrasound is a form of cyclic sound pressure with a frequency greater than the upper limit of human hearing, this limit being approximately 20 kilohertz (20,000 hertz). ... In optics one considers angles of incidence. ...


Infection

All catheters can introduce bacteria into the bloodstream, but CVCs are known for occasionally causing Staphylococcus aureus and Staphylococcus epidermidis sepsis. Binomial name Rosenbach 1884 Staphylococcus aureus , (literally Golden Cluster Seed) the most common cause of staph infections, is a spherical bacterium, frequently living on the skin or in the nose of a person, that can cause a range of illnesses from minor skin infections (such as pimples, boils, and cellulitis... Binomial name (Winslow & Winslow 1908) Evans 1916 Staphylococcus epidermidis is a member of the bacterial genus Staphylococcus, consisting of Gram-positive cocci arranged in clusters. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ...


Diagnosis

A patient with a central line, fever, and no obvious cause of the fever may have catheter-related sepsis. A meta-analysis found "Paired quantitative blood culture is the most accurate test for diagnosis of IVD-related bloodstream infection. The cultures are compared for number of colonies with line infection indicated by 5:1 ratio (CVC versus peripheral). However, most other methods studied showed acceptable sensitivity and specificity (both >0.75) and negative predictive value (>99%)".[1] This article needs additional references or sources for verification. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ...


Quantitative cultures are not commonly available. Alternatively, paired qualitative cultures in which time to positivity is assessed with line infection indicated by cultures that are positive 2 hours before peripheral cultures.[1]


This analysis did not include gram stain and acridine-orange leucocyte cytospin test (AOLC) of 100 microliters of catheter blood (treated with edetic acid) which one group of investigators proposes. [2]


The American Centers for Disease Control and Prevention recommends again routine culturing of central venous lines upon their removal.[3] However, the three cited studies do not directly address the validity of this practice.[4][5][6] The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ...


Treatment

Generally, antibiotics are used, and occasionally the catheter will have to be removed. In the case of bacteremia from staphylococcus aureus, removing the catheter without administering antibiotics is not adequate as 38% of such patients may still develop endocarditis.[7] An antibiotic is a drug that kills or slows the growth of bacteria. ... Bacteremia (Bacteræmia in British English, also known as blood poisoning or toxemia) is the presence of bacteria in the blood. ... Binomial name Rosenbach 1884 Staphylococcus aureus , (literally Golden Cluster Seed) the most common cause of staph infections, is a spherical bacterium, frequently living on the skin or in the nose of a person, that can cause a range of illnesses from minor skin infections (such as pimples, boils, and cellulitis... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ...


Prevention

To prevent infection, some central lines are now coated or impregnated with antibiotics, silver (specifically silver sulfadiazine) and or Chlorahexadine. General Name, Symbol, Number silver, Ag, 47 Chemical series transition metals Group, Period, Block 11, 5, d Appearance lustrous white metal Standard atomic weight 107. ... Silver sulfadiazine is a topical antibiotic used primarily on second- and third-degree burns. ...


A randomized control trial found that routine replacement of a new central line catheter does not help.[8] A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ...


Clinical practice guidelines from the American Centers for Disease Control and Prevention make a number of recommendations.[3] A medical guideline (also called a clinical guideline, clinical protocol or clinical practice guideline) is a document with the aim of guiding decisions and criteria in specific areas of healthcare, as defined by an authoritative examination of current evidence (evidence-based medicine). ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ...


Air embolism

Main article: Air embolism

An air embolism, or more WITCH generally gas embolism, is a medical condition caused by gas bubbles in the bloodstream (embolism in a medical context refers to any large moving mass or defect in the blood stream). ...

Haemorrhage

Arrhythmia

Arrhythmia may occur during the insertion process when the wire comes in contact with the endocardium. It typically resolved when the wire is pulled back. A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ... In the heart, the endocardium is the innermost layer of tissue that lines the chambers of the heart. ...

  • Arterial injury

Confirmation

Except in emergent conditions, confirmation will be performed to ensure proper placement. Sonography and radiography are used most often to confirm placement. Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structures and possible pathologies or lesions. ... A radiograph of a right elbow-joint Radiography is the use of certain types of electromagnetic radiation—usually ionizing—to view objects. ...


References

  1. ^ a b Safdar N, Fine JP, Maki DG (2005). "Meta-analysis: methods for diagnosing intravascular device-related bloodstream infection". Ann. Intern. Med. 142 (6): 451-66. PMID 15767623. 
  2. ^ Kite P, Dobbins BM, Wilcox MH, McMahon MJ (1999). "Rapid diagnosis of central-venous-catheter-related bloodstream infection without catheter removal". Lancet 354 (9189): 1504-7. PMID 10551496. 
  3. ^ a b O'Grady NP, Alexander M, Dellinger EP, et al (2002). "Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention". MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control 51 (RR-10): 1-29. PMID 12233868. 
  4. ^ Widmer AF, Nettleman M, Flint K, Wenzel RP (1992). "The clinical impact of culturing central venous catheters. A prospective study". Arch. Intern. Med. 152 (6): 1299-302. PMID 1599360. 
  5. ^ Pittet D, Tarara D, Wenzel RP (1994). "Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality". JAMA 271 (20): 1598-601. PMID 8182812. 
  6. ^ Raad II, Baba M, Bodey GP (1995). "Diagnosis of catheter-related infections: the role of surveillance and targeted quantitative skin cultures". Clin. Infect. Dis. 20 (3): 593-7. PMID 7756481. 
  7. ^ Watanakunakorn C, Baird IM (1977). "Staphylococcus aureus bacteremia and endocarditis associated with a removable infected intravenous device". Am. J. Med. 63 (2): 253-6. PMID 888847. 
  8. ^ Cobb DK, High KP, Sawyer RG, et al (1992). "A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters". N. Engl. J. Med. 327 (15): 1062-8. PMID 1522842. 

External links

  • Photo galleries of central line placement showing the procedure step-by-step with and without ultrasound guidance. V. Dimov, B. Altaqi, Clinical Notes, 2005. A free PDA version.
  • Complications of central line placement. V. Dimov, Clinical Cases and Images, 2005.

 
 

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