From the Guidelines
The selection of central venous catheter (CVC) lumen should be guided by the principle of using the minimum number of lumens necessary to meet the patient's clinical needs, with a preference for single-lumen catheters unless multiple ports are essential for patient management. When choosing a CVC, consider the types and compatibility of infusions required, as well as the duration of therapy.
Key Considerations
- Single-lumen catheters are suitable for patients needing only one medication or for parenteral nutrition, as recommended by 1 and 1.
- Multi-lumen catheters may be necessary when multiple incompatible medications must be administered simultaneously, but they are associated with an increased risk of infection, as noted in 1.
- Dedicated lumens should be reserved for specific purposes, such as parenteral nutrition, to prevent medication incompatibilities and catheter occlusion, as suggested by 1.
- The risk of infection increases with the number of lumens, so using the minimum number necessary is recommended to reduce complications while meeting the patient's treatment requirements, as emphasized by 1.
Lumens and Infection Risk
- The use of a dedicated lumen for parenteral nutrition (PN) infusion is recommended, as stated in 1, to minimize the risk of catheter-related bloodstream infections (CRBSIs).
- Routine drawing of blood samples from central venous access devices (CVADs) should be avoided if possible due to an increased risk of complications, as advised by 1.
Best Practice
- In general, the smallest diameter catheter and minimum number of lumens should be used to minimize the risk of catheter-related complications, as recommended by 1.
- Consider the duration of therapy, as temporary catheters are appropriate for short-term use, while tunneled catheters or implanted ports are better for long-term therapy.
- Always prioritize the patient's clinical needs and the intended use of the catheter when selecting a CVC lumen, as guided by the most recent and highest quality study, 1.
From the Research
Lumen Selection in Central Venous Catheter
The selection of central venous catheter lumen is guided by several factors, including:
- The number of infusions or medications that need to be administered simultaneously
- The type of medication or infusion being administered
- The patient's individual needs and medical condition
- The risk of catheter-related complications, such as infection or thrombosis
Factors Influencing Lumen Selection
Studies have shown that the number of lumens in a central venous catheter can increase the risk of catheter-related bloodstream infection (CRBSI) 2, 3. For example, a study published in 2008 found that each additional lumen increased the risk of CRBSI by a factor of 4.4 2. Another study published in 2003 found that multilumen catheters were associated with a slightly higher risk of infection compared to single-lumen catheters, although this relationship diminished when only high-quality studies were considered 3.
Benefits and Drawbacks of Multilumen Catheters
Multilumen catheters can provide several benefits, including increased convenience and the ability to administer multiple medications or infusions simultaneously 4. However, they also carry a higher risk of complications, such as infection and thrombosis 5, 2. A study published in 2016 found that limiting the number of lumens in peripherally inserted central catheters (PICCs) could improve outcomes and reduce costs 5.
Clinical Considerations
When selecting a central venous catheter, clinicians must weigh the benefits and drawbacks of multilumen catheters and consider the individual needs and medical condition of the patient. This may involve assessing the patient's risk of catheter-related complications and determining the minimum number of lumens required to meet their medical needs. Additionally, clinicians should be aware of the potential for catheter misplacement, particularly in patients with portal hypertension 6.