What is cvp line used for

What Are the Types of Central Lines? Doctors might use a central line instead of a regular IV line because: It can stay in place longer up to a year or even more. It makes it easier to draw blood. Patients can get large amounts of fluids or medicines like chemotherapy that might not go through regular IVs. Doctors may place a central line for someone who: has a serious infection so they can get IV antibiotics for a few weeks has cancer so they can get chemotherapy and blood tests through the line needs IV nutrition will need many blood transfusions.

Are There Risks to a Central Line? How Can Parents Help? Before your child goes home from having the central line placed, ask your health care team: how often to change the dressing when and how to flush the line what to do if the line gets blocked or comes out how to give medicines through the central line if you will be giving medicines at home if the line has caps, how often to change them which physical activities are OK for your child most kids need to avoid rough play and contact sports if any special care is needed to protect the central line while your child bathes what signs of infection to watch for Tell your child's teachers, school nurse, counselor, and physical education teacher about the central line.

The common femoral vein, otherwise known as the femoral vein, is the last of the most common sites of central line insertion. The femoral vein receives drainage from the joining of the superficial femoral vein and the deep femoral vein in the upper thigh. Once it reaches above the inguinal ligament, the femoral vein continues as the external iliac vein. The internal iliac vein combines with the external iliac vein to form the common iliac vein which eventually combines with its opposite side counterpart to become the inferior vena cava IVC.

The IVC drains into the right atrium [ 13 ]. The femoral vein is located in the femoral triangle. This is an anatomical region bounded by the inguinal ligament superiorly, the adductor longus medially, and the sartorius muscle laterally. The physician will first palpate the femoral artery by using the inguinal ligament and an anatomical point midway between the anterior superior iliac spine and the pubic tubercle.

Once the pulsation is felt, the location is easily determined because the femoral vein is always medial to the femoral artery within the femoral triangle [ 13 ]. If the findings need to be confirmed before proceeding then an ultrasound can be used to guide the procedure. There are several complications associated with central line use, regardless of the site of insertion.

Past research has demonstrated that ultrasound guidance has been shown to decrease the risk of complications at all central line access sites [ 2 , 9 ]. Complications that occur during or closely following a central line insertion are called immediate complications. The complications are categorized into the following; cardiac, vascular, pulmonary, and catheter placement complications [ 14 ]. These are caused by errors made during a central line insertion procedure [ 14 ].

So in order to reduce the occurrence of these complications, it becomes important to address these errors, how they cause the complications, and how they are managed. In , a group of physicians conducted a prospective study and recorded attempts at central venous catheterization during an eight-month period of time in the intensive care unit ICU [ 15 ].

The rates of catheterization failure and the early complications amongst the three common sites were determined. The procedures were conducted by two groups, the first being staff members and experienced residents, and the second being interns and inexperienced residents. The overall failure rate was The complication rate was 5. As mentioned earlier, reducing the rate of immediate complications means reducing the errors made during the procedure.

One such improvement has been the use of ultrasound-guided central line insertion and its effect on reducing the immediate complication rates. In a study, it was determined that ultrasound guidance during insertion significantly reduced the incidence of immediate complications from rates previously as high as Cardiac complications: Cardiac complications are considered to be one of the immediate complications seen in a central line insertion.

Physicians will encounter arrhythmias during or as an immediate result of the insertion because of the guide wire coming into contact with the right atrium [ 14 ]. As a result, premature atrial and ventricular contractions can occur [ 14 ].

Having awareness of the guide wire depth and using telemetry monitoring will help in the early recognition of arrhythmia. If it does develop, then advanced cardiac life support ACLS should be started immediately [ 14 ]. If the atrioventricular AV node is contracting for a significant amount of time then supraventricular tachycardia can occur and that can lead to a fatal arrhythmia and cardiac arrest [ 15 , 17 - 18 ].

Other cardiac complications include right ventricular perforation caused by inserting a pulmonary artery catheter, which will lead to a cardiac tamponade [ 14 ].

This will require a fast assessment and prompt removal of the patient to the operating room for a pericardiocentesis. Vascular complications: The vascular complications seen during a central line insertion are arterial injury, venous injury, bleeding, and hematoma formation [ 14 ].

Ultrasound guidance has been shown to greatly reduce the risk of vascular complications [ 17 , 19 - 21 ]. Arterial injury tends to occur most commonly in cases of femoral vein central lines and least commonly in subclavian vein central lines [ 22 ]. It was determined in a study that arterial punctures occur in about 4.

It is often recognized secondary to its characteristic pulsatile flow but it may be difficult to diagnose in patients who have a low blood volume [ 23 - 24 ]. And despite the use of ultrasound, there are still central lines that end up in the arterial system by accident [ 25 ]. The concern in that case is whether to immediately remove the catheter with pressure or leave it in place [ 14 ].

Both carry risk. Any prolonged arterial catheterization can lead to a stroke, a thrombus, and potential neurological problems. The immediate removal of an accidental arterial catheter with pressure can lead to the possible development of hemorrhage, a pseudoaneurysm, or an AV fistula [ 14 ].

The risk of hemorrhage is even greater in patients on anticoagulants or antiplatelet drugs [ 23 ]. Past research studies have determined that leaving the accidental arterial catheter in place with a quick repair will carry less morbidity and mortality rather than performing catheter removal with pressure [ 26 ].

Pseudoaneurysms are treated with compression or image-guided thrombin or coil placement. An AV fistula would be managed with an image-guided coiling procedure [ 14 ]. But if the treatment is delayed for a significant amount of time, then a direct surgical repair may be needed as a last resort. Venous injuries can also occur during a central line insertion. Past studies have reported lacerations of the vena cava, the mediastinal vessels, and the right atrium [ 14 ].

It has been hypothesized that the during the insertion, the guide wire becomes trapped against the vessel wall and the subsequent insertion of the dilator or catheter leads to that wire bending and pushing against the vessel wall [ 14 ].

This can lead to a laceration injury. A direct visualization of the guide wire using fluoroscopy can help prevent atria or venous injury [ 23 ]. Sometimes for the treatment of these injuries, surgery is performed, which can range from a direct suture repair to a complete vascular reconstruction using either autologous tissue or bovine pericardium tissue [ 14 ]. The difficulty with using prosthetic material in the venous system is that it is highly thrombogenic even if the patient is taking anticoagulant medication [ 14 ].

In the case of a venous injury resulting in life-threatening hemorrhage, urgent ligation of the bleeding vessel is done immediately. Hematoma formation has also been reported in about 4.

Most hematomas formed during central line insertions are benign but some can become sources of infection in patients and lead to abscess formation.

Blood can collect in the thorax or in the mediastinum leading to hemothorax or hemomediastinum, respectively. They would require treatment with computed tomography CT drainage. Abnormal anatomy in patients can also predispose to vascular complications occurring during a central line insertion.

In about 0. The significance of a left-sided vena cava is that it will drain directly into the left atrium versus into the coronary sinus [ 28 ]. The potential complications of a central line insertion in this situation are the development of systemic emboli and cardiac arrhythmias [ 28 ]. The anomaly can be incidentally discovered during a central line insertion in the left subclavian vein or the left internal jugular vein [ 27 - 28 ]. When it is recognized, the central line should be quickly removed and placed in either the right subclavian vein or internal jugular vein.

Device mismanagement during insertion: There have been reported cases of catheter and wire entanglement with IVC filters. In most cases, fluoroscopic visualization is utilized to correct the IVC filter entanglement [ 29 - 30 ]. Other reported cases have seen catheter entanglement in patients with multiple catheters or by entrapment with sutures during cardiothoracic surgery [ 31 ]. The entanglement often results in what physicians refer to as knotted catheters.

In order to remove them, physicians will tighten the knot of entanglement and remove the knot gently through a dilated insertion site.

Another minimally invasive technique would be to manipulate the knot under fluoroscopy. In certain cases, surgical intervention may be resorted to [ 32 - 33 ]. Guide wires during insertion can also become entrapped or even lost. Entrapped or lost wires can often be resolved with surgical intervention, traction removal, or with the use of fluoroscopic guidance [ 35 - 36 ]. Pulmonary complications: The development of a pneumothorax, a pneumomediastinum, a chylothorax, a tracheal injury, a recurrent laryngeal nerve injury, and an air embolus are among the pulmonary complications seen during a central line insertion [ 14 ].

Any injury to the parietal pleura during insertion will lead to pneumothorax or pneumomediastinum formation. They are seen most commonly with subclavian vein central lines and occur in about one percent of cases [ 16 , 22 , 24 ].

A larger sized catheter and an increased number of attempted insertions will raise the risk for pneumothorax. Other pulmonary complications seen are chylothorax and chylopericardium [ 37 ]. These conditions can be caused by venous congestion or an injury to the lymphatics. The left internal jugular vein and subclavian vein have a higher risk of lymphatic injury due to the anatomic location of the thoracic duct [ 14 ].

In the superior mediastinum, the thoracic duct passes behind the left internal jugular vein. The course of the thoracic duct finally terminates when it empties into the junction of the left subclavian and internal jugular veins. Despite this, a lymphatic injury can still occur with a central line inserted into the right internal jugular vein or subclavian vein. Lymphatic injuries can be treated with nitric oxide, thoracoscopic fibrin glue, or percutaneous coiling [ 17 ].

Recurrent laryngeal nerve injuries have had an incidence of 1. It is due to accidental trauma or perineural hematoma formation [ 14 ]. Other nerves that have also been injured are the sympathetic chain, the brachial plexus, and the phrenic nerves. The recovery time for an injury to the recurrent laryngeal nerve can take between six months and one year [ 14 , 17 , 38 ].

Past research studies have also noted the incidence of tracheal injuries during a central line insertion. Surgical repair is needed for treatment [ 14 ]. The last known pulmonary complication is the development of an air embolism. These can occur during a central line insertion or when flushing the venous catheter. Small air embolisms less than several cubic centimeters are of little significance and can be self-resolving.

If treatment is issued for them, then supplemental oxygen and increased systemic pressures are utilized to reduce the air bubble [ 40 ]. In extreme cases, hyperbaric oxygen therapy may be used to reabsorb the air [ 41 ]. The delayed complications of a central line insertion include infection and device dysfunction. These complications are much more gradual in onset and can occur in the weeks to months after a central line insertion [ 14 ].

Infections: Infections of the central line can lead to sepsis, shock, and death. The incidence of a central line-associated infection is between episodes per , patient years [ 42 ]. Infections are linked to biofilm formation on the venous catheter with Staphylococcus aureus and Staphylococcus epidermidis bacteria being the two most common pathogens [ 14 , 43 ].

If a central line bloodstream infection is suspected, then two blood cultures should be drawn from separate sites before starting broad-spectrum antibiotics [ 14 ].

Broad-spectrum antibiotics should be given according to culture sensitivity [ 44 ]. Device dysfunction: A device dysfunction is when there is a problem with the mechanical components of the central line. A dysfunction of one them can lead to delayed complications like a fibrin sheath, a catheter fracture, a thrombosis, stenosis, or an infection. The rate of device dysfunction is directly related to the central line site, the duration, and the underlying patient comorbidities.

The development of a fibrin sheath can occur within the first week of central line insertion and can create blockages at the distal openings. The healthcare provider flushes the catheter with saline solution to clear it. The solution may include heparin. This prevents blood clots. An X-ray or other imaging test is done. Risks and possible complications As with any procedure, having a central line placed has certain risks.

These include: Infection Bleeding problems An irregular heartbeat Injury to the vein or to lymph ducts near the vein Inflammation of the vein phlebitis Air bubble in the blood air embolism. An air embolism can travel through the blood vessels and block blood flow to the heart, lungs, brain, or other organs.

Blood clot thrombus that can block the flow of blood. A blood clot can also travel through the blood vessels. It can block blood flow to the heart, lungs pulmonary embolism , brain, or other organs. Collapsed lung pneumothorax or blood buildup between the lungs and the chest wall hemothorax Nerve injury Accidental insertion into an artery instead of a vein Catheter not positioned correctly If you have any problems with your central line, talk with your healthcare provider.

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