Central venous catheterisation - 1

Background

Central venous lines are generally used for
- haemodynamic monitoring that is unable to be measured by non invasive means
- to deliver drugs and nutritional supplements that are unable to be given peripherally (too concentrated/toxic/irritant)

The main complications can be related to
- insertion
- infection
- thrombosis    
 

Avoiding complications  

The principles of using central venous lines should be to insert the catheter:
- quickly
- aseptically
- with minimal tissue trauma

And then to:
- take the catheter out as soon as possible.    
 

Antimicrobial impregnated catheters

Catheter-related bloodstream infections are associated with substantial morbidity and mortality. Trials suggest that central venous catheters impregnated with antibiotics may prevent some of these infections.

However practices which may make economic sense in an environment with large numbers of long term intensive care patients may not be effective or justified elsewhere.

Use of these catheters may increase antibiotic resistant organisms.    
 

Multi-lumen vs. single lumen catheters 

The choice of a single or multilumen catheter depends on what it is being used for - monitoring, nutritional support or drug therapy.

For critical care, a three lumen catheter is often the preferred type as it has one large bore (16G) for i.v. fluids/blood and two smaller (18G) channels for other infusions or monitoring.

Resistance to flow is proportional to the length of a tube, therefore central lines are poor for rapid fluid resuscitation. However sometimes they are the only route available. 
 

Quiz question 1

 

Which of the following is NOT a good reason for a central venous catheter (CVC) to be inserted ?

 

1) administration of total parenteral nutrition (TPN.)

2) to give large volumes of iv fluid very quickly.

3) to deliver medications that are too irritant to be given peripherally.

4) measurement of central venous pressure

 

Show answer


 

next page