CENTRAL VENOUS

CATHETER

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I. DEFINITION

WHAT IS CVC?
• A synthetic, relatively large
tube available in varying
diameters that is placed into a
high flowing vein.

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II. INDICATIONS

• Is not suitable candidate for AVF or AVG (i.e. peripheral vascular

disease)
• Has a plan in place to undergo surgery for AVF or AVG
• Has maturing AVF or AVG in place
• Is waiting for a scheduled live donor transplant
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III. BASIC PARTS OF THE CATHETER

1. TIP
2. HUB
3. CAP 5 1
4. LIMB or TAIL 4
5. EXIT SITE CUFF 6
6. CLAMP 2 (internal ) 3 (external)

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IV. CATHETER DESIGNS
• A. Traditional catheter
connected by a luer lock
• B-C. Implantable ports that can
be accessed by a needle
• D-E. Conjoined lumens
• F. Completely separated
• G. Partially separated
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V. CATHETER TYPES
CUFFED versus NON-CUFFED

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 TUNNELED, CUFFED CATHETER (TCC)

• A CVC that travels a distance under the skin from the point of
insertion before entering a vein and terminated at or close to the
heart or one of the great vessels
• Cuff is positioned subcutaneously about 1 cm from exit site inside
the tunnel

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 NON-TUNNELED, NON-CUFFED CATHETERS
(NCC)

• a CVC that is fixed in place at the point of insertion, goes directly

from the point of entry and terminates close to the heart or one
of the great vessels
• lacks a subcutaneous cuff and does not offer a barrier to infection
• for short-term use only (3-5 dialysis treatments within 1 week)
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VI. ANATOMIC LOCATIONS

1. INTERNAL JUGULAR
2. FEMORAL VEIN
3. SUBCLAVIAN VEIN

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 INTERNAL JUGULAR

FEMORAL VEIN

SUBCLAVIAN VEIN

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 INTERNAL JUGULAR VEIN

A. RIGHT INTERNAL B. LEFT INTERNAL JUGULAR

JUGULAR VEIN
• - preferred site because it offers a
more direct route to the right
atrium than left-sided great veins
VEIN
• - poorer blood flow rates and
higher rates of stenosis and
thrombosis than RIJ due to
increased length

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 FEMORAL PLACEMENT

• - highest infection rates

• - the catheter tip must be in
the inferior vena cava to avoid
regional circulation
• - should be avoided to
transplant candidate

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SUBCLAVIAN VEIN

• - must be strictly avoided

• - can permanently exclude the
possibility of a long-term
upper arm fistula

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 VII. ADVANTAGES OF CVC

• 1. can be applied to all patients

• 2. can be inserted into multiple sites relatively easily
• 3. require no maturation time
• 4. cause no change in cardiac output
• 5. can they provide an immediate access for dialysis, but can also can remain
in place over a period of months permitting time for a fistula to mature

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 VIII. DISADVANTAGES OF CVC

• Infection rate
• Permanent central venous
stenosis or occlusion

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 IX. COMPLICATIONS OF CVC

1. IMMEDIATE ISSUES
2. INFECTION
3. CENTRAL VENOUS STENOSIS
4. CATHETER DYSFUNCTION
• THROMBOSIS

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1. IMMEDIATE ISSUES
• Bleeding
• Catheter malposition or kink
• Vein perforation
• Carotid artery and femoral artery
damage
• Thrombosis
• Cardiac arrhythmias
• Pneumothorax
• Hemothorax

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2. INFECTION
• EXIT SITE INFECTION – is localized to the area
aound the exit site. It does not extend beyond the
cuff in TCC; positive culture is obtained
• TUNNEL INFECTION – occurs when the tract
superior to the cuff is inflamed and painful
• CATHETER-RELATED BACTEREMIA – positive
blood cultures with or without the accompanying
symptom of fever

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3. CENTRAL VENOUS STENOSIS

Causes:
1. Site insertion
2. Number of duration of catheter uses
3. Occurrence of infection
4. Due to endothelial injury, inflammation,
stenosis, and vein occlusion

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4. CATHETER DYSFUNCTION
• attainable blood flow rate is <300 ml/min and arterial pressure more
negative (-) 250mmHg

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 Causes:
Mechanical Problems
1. Poor placement
2. Kink in the catheter
3. Partial withdrawal with or without cuff exposure
4. Cracked hub or broken clamps
5. Patient positioning
6. Thrombosis or fibrin sheath
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*THROMBOSIS
Types:

Causes:
• Endothelial trauma that occurs
with initial insertion leads to
endothelial vessel wall damage
• Activation of coagulation cascade
• Changes in the blood flow

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IX. MANAGEMENT OF CVC COMPLICATIONS
A. INFECTION
1. Observing hand hygiene
2. Aseptic technique when connecting or disconnecting catheters
3. Strict adherence to infection control and access care
4. The use of neutral-valve closed-system connectors
5. Antibiotic lock therapy may be used where the patient is clinically stable
and/or the catheter the reinfected with the same organism and catheter
sites are limited
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B. CENTRAL VENOUS STENOSIS

Management
1. Notify the physician
2. Removal of any obstruction
3. Thrombolytics
4. Angioplasty to identify stenosis
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C. CATHETER DYSFUNCTION

Management
• Flush CVC with normal saline to determine if the dysfunction is due to
position or clot
• Blood can easily be withdrawn – malposition of the tip
• After flushing, brisk blood return is not attainable – occluded by a fibrin sheath or clot
• Line reversal is attempted to increase blood flow rate as a temporary fix
• 86% recirculation

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D. THROMBOSIS

Potential Interventions and treatments

• Trending of catheter flow
• Catheter locks per facility
• Thrombolytic
• Antibiotic
• Referral for imaging
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 XII. NKF KDOQI GUIDELINES
Avoid if possible: Long-term catheters.

• Short-term catheters should be used for acute dialysis and for a limited duration in
hospitalized patients. Noncuffed femoral catheters should be used in bed-bound patients
only.
• Long-term catheters or dialysis port catheter systems should be used in conjunction with a
plan for permanent access. Catheters capable of rapid flow rates are preferred. Catheter
choice should be based on local experience, goals for use, and cost.
• Long-term catheters should not be placed on the same side as a maturing AV access, if
possible.

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 XII. NKF KDOQI GUIDELINES
Catheters and Port Catheter systems:

• The preferred insertion site for tunneled cuffed venous dialysis catheters or port catheter
systems is the right internal jugular vein. Other options include the right external jugular
vein, left internal and external jugular veins, subclavian veins, femoral veins, and
translumbar and transhepatic access to the IVC. Subclavian access should be used only
when no other upper-extremity or chest-wall options are available.
• Ultrasound should be used in the placement of catheters.
• The position of the tip of any central catheter should be verified radiologically.

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GLOBAL NEPHRO TRAINING CENTER 32

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