Central Venous Catheter - Types, Uses and Complications

A central venous catheter or central venous line is a temporary catheter placed into a large vein, with an intention to keep it for the required period and administer drugs, blood products, and other fluids and as well as to draw blood for investigation.

Insertion of a central venous catheter in a human was first reported by Werner Forssman, in 1929. Seldinger in 1953 developed a technique of putting these catheters into the lumen of veins and is quite popular as modified Seldinger technique now.

Central venous catheters are now common among critically ill patients or in patients who require venous access but do not have accessible peripheral veins [as in extensive burns].

Central venous catheters usually remain in place for a longer period than other peripheral venous access devices such as a cannula.

Types of Central Venous Catheters

Site of Insertion

Internal jugular central venous catheter
Subclavian central venous catheter
Supraclavicular central venous catheter
Femoral central venous catheter
Peripherally Inserted Central Catheter (PICC)

Pediatric central line is a central venous catheter that is used in children and the most preferred site is femoral.

Non-tunneled Catheters

These catheters are Non-tunneled catheters are fixed in place at the site of insertion, with the catheter and attachments protruding directly. [Most of the catheters are inserted this way]

Tunneled Catheters

Tunneled catheters are passed under the skin from the insertion site to a separate exit site. For example internal jugular or subclavian is passed under the skin to emerge at the chest, making the access ports less visible than catheters that protrude directly from the neck. Passing the catheter under the skin helps to prevent infection and provides stability. Hickman catheters and Groshong catheters are examples of the tunneled catheter.

Implanted port

When a tunneled catheter is left entirely under the skin, it is called port. Medicines are injected through the skin into the catheter. Some implanted ports contain a small reservoir that can be refilled in the same way. After being filled, the reservoir slowly releases the medicine into the bloodstream. An implanted port is less obvious, requires little daily care, easier to maintain and carry a lesser risk of infection.

Ports are used on patients who require only occasional venous access but for a long duration course of therapy. They are not suitable when frequent venous access is required.

Lumen of Catheters

Depending on use, catheters may have a single lumen or multiple lumens. A catheter with two lumens is “biluminal”, three “triluminal”. Up to 4 or 5 lumens may be used.

Indications for Central venous catheters

Central venous pressure monitoring
Resuscitation requiring high volume or flow
Emergency venous access
Inability to obtain peripheral venous access
Repetitive blood sampling
Administration of
Hyperalimentation [parentral nutrition esp when long term]
Caustic agents
Concentrated fluids
Chemotherapy
Drugs that are prone to cause phlebitis in peripheral veins
- Calcium chloride
- Chemotherapy
- Hypertonic saline
- Potassium chloride (KCl)
- Amiodarone
- Vasopressors (for example, epinephrine, dopamine)
- Long-term intravenous antibiotics
Insertion of transvenous cardiac pacemakers
Hemodialysis or plasmapheresis
Insertion of pulmonary artery catheters
Plasmapheresis
Peripheral blood stem cell collections
Dialysis
Frequent blood draws
No peripheral access present in face of the need for intravenous therapy

Contraindications to Central Venous Catheters

Absolute contraindications

Infection over the placement site
Anatomic obstruction (thrombosis of the target vein, other anatomic variance)
Site-specific issue- e.g. trauma/fracture to ipsilateral clavicle or proximal ribs

Relative contraindications

Coagulopathy
Preferentially use a compressible site such as the femoral location and avoid the internal jugular and subclavian.
Distorted landmarks
- Trauma
- Congenital anomalies
Prior vessel injury or procedures
Morbid obesity
Uncooperative patient

Insertion of Catheter

The detailed methods are given when individual catheters are discussed. Here the method is only briefly touched.

The area of skin over the planned insertion site is cleaned. A local anesthetic is infiltrated. if necessary.

The location of the vein is identified by landmarks or with the use of a small ultrasound device. A hollow needle is advanced through the skin until blood is aspirated.

The line is then inserted using the Seldinger technique [the most common technique used now]

A blunt guidewire is passed through the needle, then the needle is removed. After the guidewire is positioned in the vein, a dilator is passed over the guidewire to expand the tract and removed. Finally, the catheter is passed over the guidewire and positioned. The guidewire is now removed.

All the lumens of the line are aspirated and flushed with either saline or heparin.

The position of the catheter is confirmed by a chest X-ray. A chest x-ray also helps to find if there is a breach of pleura and presence of a pneumothorax.

On anteroposterior X-rays, a catheter tip between 55 and 29 mm below the level of the carina [a ridge of cartilage in the trachea that occurs between the division of the two main bronchi].

Electromagnetic tracking can be to provide guidance during insertion and to verify tip placement and in such cases, x-rays are not required.

The catheter is then secured in place by an adhesive dressing, suture, or staple and covered by an occlusive dressing. Regular flushing with saline or a heparin-containing solution is advised to keep the line open.

Some venous catheters are impregnated with antibiotics or silver-containing substances to reduce infection risk.