Central venous access is the insertion of a catheter into a major central vein (typically in the neck, chest or groin) in order to achieve consistent access to the blood stream. It is also commonly in situations where patients need long-term intravenous therapy or rapid fluid replacement as well as central venous pressure monitoring.
What is Central Venous Access?
Central venous access refers to the placement of a central venous catheter (CVC) in a major vein usually internal jugular vein, subclavian vein, or femoral vein. It does not involve usage of peripheral IV lines as it provides access directly to central circulation to perform specialized treatment.
Indications
Treatment with vasoactive medications, chemotherapy, antibiotics or parenteral nutrition.
Fluid and blood product infusion in case of an emergency.
Internal jugular vein (commonest; can be ultrasound guided)
Subclavian vein (good long-term patency although with increased risk of pneumothorax)
Femoral vein (easy approach, but with greater risk of infection/thrombosis)
Benefits
Stable and permanent venous access.
Safety in the administration of irritant or vesicant drugs.
Can be used in the case of critically ill patients and cancer treatment.
Central venous catheter insertion in India
Central Venous Catheter (CVC) Insertion - Central Venous Catheter (CVC) insertion, also known as Central Line Insertion is a medical intervention conducted by inserting a thin and flexible pipe (catheter) into a large vein to administer medications, fluids, nutrition, or to check measurements of the central venous pressure.
Overview
A catheter of this type, a central venous one, typically goes through one of the great veins in the:
Neck (Internal Jugular vein)
Chest (Subclavian vein)
Groin (Femoral vein)
It is applied in case of long-term intravenous access or in cases where peripheral veins are inappropriate.
Indications
IV drugs (chemotherapy, antibiotics, etc.)
Total parenteral nutrition (TPN).
Colonial peripheral pressure measurement.
Dialysis access (temporary)
Frequent blood sampling
Emergency administration of fluids or blood.
Classifications of Central Venous Catheters
Non-tunneled catheter- to be used on a short-term basis (ICU or emergency)
Aseptic hand technique: Full barrier precautions (mask, gown, gloves, drapes)
Material: Central venous catheter set, ultrasound, sterile flushes.
Patient Positioning
Internal jugular / subclavian vein: Supine, Trendelenburg (15-20° head-down) to distend veins and minimize risk of air embolism.
Femoral vein: Supine, leg high abducted and out-rotated.
Site Selection
As internal jugular vein (preferably, ultrasound-guided)
Subclavian vein (good long-term but increased pneumothorax)
Femoral vein (raiser, yet more infected)
Local Anaesthesia
Lidocaine 1% infiltrated.
Insertion Technique (Seldinger Method)
Insertion of needles - Under ultrasound guidance, the advancement of the needle should be done until the venous blood is aspirated.
Guidewire insertion- Insert the needle through the vein with the guide wire.
Removal of needles - Take out needle, leaving guidewire
Dilator insertion -Insert dilator over guidewire, then withdraw dilator.
Placing of catheters- Pass the central venous catheter through the guide wire.
Guidewire withdrawal - Removal of guidewire whilst maintaining the catheter.
Secure catheter- Suture or adhesive device; place sterile dressing.
Flush lumens- Ascertain free aspiration and flushing of all ports.
Confirmation
Chest X-ray (to rule out pneumothorax) to ensure that the tip lies in the superior vena cava (SVC).
Real-time confirmation some settings with ultrasound / fluoroscopy.
Post-procedure Care
Periodically examine the area of insertion as to infection or bleeding.
Maintain sterile dressings.
Flush pipe to avoid the formation of a clot.
Follow up (complications: fever, swelling, dyspnea, arrhythmias).
Central venous access treatment in India GetWellGo
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