From the Guidelines
The use of a CVC line is recommended for patients requiring long-term intravenous therapy, with the internal jugular or subclavian veins being the preferred insertion sites, and ultrasound guidance being used for insertion to minimize complications, as supported by the most recent and highest quality study 1. When considering the insertion of a CVC line, it is essential to weigh the benefits and risks, taking into account the patient's medical history, physical examination, and laboratory and radiological tests.
- The procedure should be performed under strict sterile conditions, in the operating room, and under local anesthesia, with or without sedation, using chlorhexidine solutions with alcohol for skin preparation, as recommended by 1.
- The choice of vein for insertion is crucial, with the internal jugular or subclavian veins being preferred over the femoral vein due to the increased risk of infection and thrombosis associated with the latter, as noted in 2 and 1.
- Ultrasound guidance is strongly recommended for all CVC insertions, as it is associated with a lower incidence of complications and a higher rate of success than 'blind' venepuncture, as supported by 2.
- After insertion, proper positioning of the CVC line should be confirmed with a chest X-ray, and patients should be monitored for signs of infection, catheter displacement, or blood clots, with daily care including keeping the site clean and dry, and dressing changes performed by healthcare professionals every 5-7 days using chlorhexidine solution, as recommended by 1.
- The use of antimicrobial prophylaxis to prevent catheter colonization is not recommended, as stated in 1.
- Regular flushing of the CVC line with saline is recommended to maintain patency, with the frequency of flushing depending on the type of device and its usage, as noted in 1.
From the Research
Central Venous Catheter (CVC) Line
- A CVC line is a type of catheter used for patients undergoing hemodialysis, cancer treatment, or other medical procedures that require long-term access to the bloodstream 3.
- The use of CVCs is associated with risks such as catheter-related bloodstream infections (CRBSIs), thrombosis, and central vein stenosis 3.
Prevention of Catheter-Related Infections
- Prophylactic antibiotics may not reduce gram-positive CVC-related infections when administered prior to CVC insertion 4.
- Flushing and locking CVCs with an antibiotic solution may reduce the risk of gram-positive CVC-related infections 4.
- Antimicrobial lock solutions, including antibiotic and non-antibiotic solutions, may reduce the incidence of catheter-related infections in patients undergoing hemodialysis 5.
- Antimicrobial-coated CVCs may also reduce the risk of CRBSIs 6.
Maintenance and Care of CVCs
- Proper care and maintenance of CVCs, including regular flushing and locking, are crucial to prevent complications such as CRBSIs and thrombosis 7.
- Evidence-based clinical recommendations for CVC insertion and maintenance are available to guide healthcare professionals in providing safe and effective care 7.