Central Venous Catheter (CVC)

INTRODUCTION

Central Venous Catheter (CVC) is a catheter placed into a large vein to obtain an intravenous access. Its use has become indispensable in the management of critically ill patients. Central venous catheters are used for hemodynamic monitoring, measurement of Central Venous Pressure, hemodialysis / plasmapheresis and in setting of difficult peripheral venous access in critically ill patients. Despite its benefits, central venous catheters have drawbacks as well. Insertion of central venous catheters can be associated with mechanical complications like arterial puncture, hematoma formation and pneumothorax and hemothorax. Late complications include catheter related bloodstream infection and catheter related local infection.
Earlier

This technique had the advantage of use of thinner bore needles, less vessel wall damage and less risk of extravasations. This technique is still the benchmark in terms of placement of the central venous lines. The use of this technique provides greater safety in internal jugular and subclavian vein cannulation. (2) It is also used in various non-vascular interventions like tumour biopsy/ embolization, percutaneous cholangiogram, percutaneous nephrostomy etc. (3)
Central venous catheters can be inserted through a proximal central vein commonly the internal jugular, subclavian or femoral vein, or through a peripheral vein. The catheter is threaded through the vein till the tip reaches a large vein near the heart. The tip of the central venous catheter lies in the superior vena cava, the right atrium or the inferior vena cava.
Central venous catheters are used for rapid administration of medications, fluids, blood products and parenteral nutrition to the patient. They are also used to measure central venous pressure. Central venous catheters may have up to five lumens.
Central venous catheters can be associated with thrombosis, infectious complication and mechanical complications during insertion. An ideal central venous catheter should have ease of insertion, low thrombogenecity and a low rate of infectious complications.

The preferred site of insertion of a central venous catheter depends on various factors including the skill and expertise of the operator and the availability and experience in ultrasound guided insertion of catheter. Patient related factors including risk of bleeding and pneumothorax and the urgency of placement of the central venous catheter also play a role in determining the site of insertion of the central venous