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CENTRAL VENOUS CATHETERS

Central venous catheters are used to administer chemotherapy, hyperalimentation (intravenous feeding) , narcotics, antimicrobial agents, blood and blood components, and can be used for blood sampling. These catheters are threaded into the subclavian or jugular vein or the superior vena cava at or above the junction of the right atrium. The versatility of the central venous catheters allows the patient to receive treatment, safely, in a variety of health-care settings and at home.

TYPES OF CATHETERS

Subclavian catheter:

  • Single and multi lumen (dual, triple, quadruple lumens)
  • Short-term use - less than 60 days
  • Sutured in place
  • Sterile dressing change three times a week for duration of placement
  • Change caps every 7 days
  • Allows simultaneous administration of potentially incompatible medications and fluids
  • Requires heparinization of each lumen every 12 hours (usually 100 u heparin per cc)

Tunneled Catheters: Hickman, Broviac, Quinton, Raaf catheters

  • Long term use -- 1 to 2 years
  • Subcutaneously tunneled with a dacron cuff to keep it in place
  • Sterile dressing change three times first week or until exit site healed; then dressing is optional
  • Change cap every 7 days
  • Requires daily flushing with heparinized saline (usually 100 u per cc) when not in use
  • Repair kits available

Groshong Catheter
Same as Hickman or Broviac catheters except it has a closed distal tip and requires daily flushing with normal saline only.

Implantable Ports: Venous placement, single and dual lumen

  • Types include Infuse-A-Port, Life Port, Port-A-Cath, and Medi Port
  • Usual placement chest but can be placed in forearm (PAS port)
  • Long term use 1-2 years
  • Allows up to 2000 punctures
  • Requires Huber needle for port access
  • Change Huber needle every 5-7 days
  • Sterile dressing change 24 hours after placement, then whenever Huber needle is changed, or until suture is healed
  • Port requires monthly heparinization when not being used
  • Minimal self-care requirements
      • NOTE: Implantable ports are also used for epidural, intraarterial, and intraperitoneal infusion of medications in concentrations adapted to these ports, not to be used for IV fluids.

PICC (Peripherally Inserted Central Catheter): single and dual lumen

  • Long-term use -- up to one year
  • Inserted by MD or certified RN
  • Placement should be verified by X-ray if tip placed in SCV, X-ray optional if tip placement is mid-clavicular
  • Sterile dressing change 24 hours after placement then once a week for duration of placement
  • Change cap(s) every 7 days
  • Requires flushing with heparinized saline (usually 100 u heparin per cc) every 12 hours

POTENTIAL COMPLICATIONS-CENTRAL VENOUS CATHETERS

Air Embolus

Symptoms:

  • Chest pain
  • Cyanosis
  • Increased pulse and respirations
  • Decreased blood pressure
  • Coughing

Treatment:

  • Monitor vital signs
  • Administer oxygen
  • Initiate peripheral IV

Catheter Dislodgment:

Symptoms:

  • Medication or fluid leaking from catheter or exit site

Treatment:

  • Refer patient to surgeon Never migrate a catheter that has migrated out

Catheter Occlusion

Symptoms:

  • Unable to inject fluid or medication

Treatment:

  • Inject fibrinolytic agent such as UROKINASE 1 ml (5000 u/ml) into catheter or port using a 3cc syringe, after 30 minutes try to aspirate clot; repeat as needed
  • Hydrochloric acid (HCL) can be used to restore patency of catheters obstructed by drug precipitate such as etoposide, calcium salts plus sodium bi-carb, parenteral nutrition solution, or heparin plus an incompatible antibiotic such as amikacin or vancomycin. Instill 0.2 to 1 ml of solution (0.1 molar HCL) into obstructed catheter, leave for several hours, then withdraw 5 cc of fluid and discard.

Catheter Sepsis

Symptoms:

  • Inflamed, reddened, painful catheter exit or port site
  • Purulent exudate
  • Elevated temperature (usually > 102F)

Treatment:

  • Culture catheter exit site, port site, extension tubing and obtain blood from cultures from infected catheter and from peripheral site
  • Administer appropriate antibiotics (usually, gram positive cocci isolated in blood culture)

Deep Vessel Thrombosis

Symptoms:

  • Edema and tenderness of neck, shoulder and arm on the same side as the catheter

Treatment:

  • Remove catheter ASAP Heparin therapy (may or may not be used because the clot does not usually propagate)