What is the concern with Central Venous Catheter (CVC)?

From the Guidelines

Central Venous Catheters (CVCs) should be placed at a site that minimizes the risk of infectious complications, with the subclavian site being preferred in adult patients, while avoiding the femoral vein due to increased risk of infection and thrombosis 1.

Key Considerations for CVC Placement

• The choice of CVC type and location of exit site should be made by a multidisciplinary team, including an experienced specialist and the patient 1.
• Tunneled CVCs or totally implantable devices are usual choices for long-term use 1.
• The exit site of the catheter should be easily visible to the patient for self-care, and consideration should be given to proximity to wounds, prior exit sites, tracheotomies, stomas, or fistulae 1.
• Placement of the tip of lines using internal jugular and subclavian approaches should be near the junction of the superior vena cava and right atrium to decrease the risk of thrombosis 1.

Recommendations for CVC Care

• Regular care includes flushing with heparin or saline solution (typically 5-10 mL), sterile dressing changes every 5-7 days, and monitoring for complications such as infection, thrombosis, or mechanical problems 1.
• Ultrasound guidance should be used for CVC placement, if available, to reduce the number of cannulation attempts and mechanical complications 1.
• Prompt removal of any intravascular catheter that is no longer essential is recommended to minimize the risk of complications 1.

From the Research

Central Venous Catheters (CVCs)

• CVCs are considered the standard of practice for administering chemotherapy, fluid therapy, antibiotic therapy, and parenteral nutrition 2
• They are broadly divided into tunneled or non-tunneled catheters, with tunneled catheters further subdivided into totally implanted and totally not implanted devices 2
• Device selection depends on factors such as availability of peripheral veins, expected duration of therapy, and desired flow rate 2

CVC Placement and Care

• Ultrasound-guided access is the safest technique for central venous access compared to the landmark technique 2
• Important aspects in preventing infection in central venous catheters include the method of central venous access, subcutaneous tunneling, dressing change techniques, and catheter-intravenous tubing connection care 3
• The use of heparin can help prevent thrombosis and catheter occlusion, while medical treatment with urokinase may be necessary to clear occluded catheters 3

Alternative Access Routes

• Arteriovenous fistulae can be used as a dual access for hemodialysis and total parenteral nutrition administration, providing a feasible alternative to traditional CVCs 4
• This approach can help reduce the risk of central venous stenosis or occlusion associated with multiple central line placements 4

Optimizing CVC Use

• Maximizing prescribed blood pump speed in CVCs can improve small solute clearance, regardless of line position 5
• Clinically-indicated replacement of peripheral venous catheters may be a viable alternative to routine replacement, reducing costs and minimizing unnecessary catheter replacements 6