What are the options for Central Venous Catheter (CVC) access?

From the Guidelines

Central line access options include non-tunnelled catheters, tunnelled central catheters, fully implantable or surgically implantable catheters, and PICCs, with the choice of device depending on the duration of use and patient-specific factors. For short-term use, non-tunnelled catheters are indicated, while tunnelled central catheters and fully implantable or surgically implantable catheters are used for long-term access [ 1 ]. The main sites for central venous access devices are the internal jugular, external jugular, and sub-clavian veins, with the internal jugular vein being a preferred site due to its straight course to the superior vena cava and lower risk of pneumothorax [ 1 ]. Some key considerations for central line placement include:

• Using strict sterile technique to minimize infection risk
• Confirming proper placement with chest X-ray or blood gas analysis
• Being aware of potential complications such as pneumothorax, arterial puncture, or infection
• Using ultrasound guidance to improve success rates and reduce complications [ 1 ]. The most recent and highest quality study [ 1 ] provides guidance on the selection and management of central venous access devices, emphasizing the importance of careful preoperative assessment, strict sterile conditions, and proper catheter care to minimize the risk of complications. In terms of specific insertion techniques, the study recommends:
• Insertion of an implantable venous access device under strict sterile conditions in the operating room [ 1 ]
• Use of chlorhexidine solutions with alcohol for skin preparation [ 1 ]
• Verification of catheter tip position with radiologic confirmation or intracavitary ECG method [ 1 ]. Overall, the choice of central line access option and insertion technique should be individualized based on patient-specific factors and guided by the most recent and highest quality evidence [ 1 ].

From the FDA Drug Label

LIMITED POPULATION: DEFENCATH® is indicated to reduce the incidence of catheter-related bloodstream infections (CRBSI) in adult patients with kidney failure receiving chronic hemodialysis (HD) through a central venous catheter (CVC). The options for Central Venous Catheter (CVC) access are not explicitly stated in the provided drug labels. However, it can be inferred that the jugular vein is one possible location for CVC access, as mentioned in the drug label 2.

• Possible location: jugular vein No other options for CVC access are directly mentioned in the provided drug labels 2, 2, or 2.

From the Research

Options for Central Venous Catheter (CVC) Access

The options for CVC access include:

• Peripherally Inserted Central Catheters (PICCs) 3, 4, 5, 6
• Centrally Inserted Central Catheters (CICCs) 3, 5, 6, 7
• Totally Implantable Catheters 6

Characteristics of Each Option

• PICCs:
  • Inserted into peripheral veins of the arm 3
  • Lower risk of bloodstream infections and thrombosis when inserted using ultrasound guidance 3, 5
  • May be associated with increased risk of deep vein thrombosis, but this risk is minimized with smaller diameter and single-lumen PICCs 5
• CICCs:
  • Inserted into central veins 3
  • May be associated with higher risk of complications, such as bloodstream infections and thrombosis 3, 5
• Totally Implantable Catheters:
  • May be preferred for patients who need intermittent long-term and high-dose chemotherapy 6

Considerations for Choosing a CVC

• The choice of CVC should depend on the clinical situation and patient needs 6
• Healthcare professionals should be aware of the different clinical performance and risks associated with each type of CVC 3
• Proper management of CVCs is crucial to minimize complications and guarantee longevity to the CVC 3