Safe, Reliable, and Affordable Central Venous Access for International Patients

Central venous access in India

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.
• Hemodynamic (central venous pressure, mixed venous oxygen saturation)
• Plasmapheresis or Hematodialysis.
• Inadequate accessibility of the peripheral veins.

Sites of Insertion

• 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)
• Tunneled catheter (e.g., Hickman line) -long-term.
• Peripherally Inserted Central Catheter (PICC line) - via vein in an arm.
• Implantable port (Port-a-Cath)- to access intermittently on a long-term basis.

Procedure Steps

Preparation

• Explanation and patient consent.
• Aseptic precautions
• Ultrasound guidance (when it is available)
• Local anaesthesia of the place of insertion.

Insertion

• The needle is used to make a large central vein.
• Through the needle, a guidewire is inserted into the vein (Seldinger technique).
• The guidewire is passed behind the catheter.
• The guide-wire is withdrawn, and catheter lumens flushed.
• Catheter attached and dressing put on.

Confirmation

• Chest X-ray (except at femural site) is performed to verify the tip placement and exclude such complications as pneumothorax.

Duration

• Procedure time: 20–40 minutes
• Hospital stay: Could be diverse, based on underlying condition and objective.

Aftercare

• Maintain a clean and dry insertion site.
• Frequent change in dressing (recommended).
• Observes redness, swelling, or discharge.
• Saline/heparin flush catheter as ordered.
• Inform about pain or report fever immediately.

Best hospitals for central venous access in India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Factors Affecting Central venous access surgery cost in India

The most important factors influencing the cost of central venous access (CVA) procedures / surgery in India are:

What central venous access procedures entail cost-wise?

The costs of CVA are:

• Cost of device / catheter (material)
• Surgeon, anaesthetist procedure charges
• Operating room / OT time
• Imaging / guidance (ultrasound, fluoroscopy, X- ray)
• Consumables (sterile clothes, dressings, suture, guidewires, etc.)
• Hospital admission / bed costs (in case inpatient) / recovery room.
• Pre-procedure (lab tests, imaging) diagnostic tests.
• Follow up / maintenance (dressings, flushes, replacement where necessary)
• Treatment of complications (infection, thrombosis, etc.)

Central venous access procedure for ICU patients India

The following is a simple and an organized description of the Central Venous Access Procedure:

Preparation

• Patient evaluation: Pointers, contraindications, coagulation profile.
• Consent: describe risks, benefits, options.
• Observation: Pulse oximetry, ECG, blood pressure.
• 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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