Central venous catheters are used to deliver hyperosmolar solutions, measure central venous pressure, infuse parenteral nutrition, or infuse multiple IV solutions or medications.
These catheters may also be called a central line. Based on the type of insertion the terms centrally inserted central catheter (CICC) and peripherally inserted central catheters (PICC) may be used. The term vascular access device (VAD) may also be used. Catheter position is determined by radiography after insertion. The catheter may have a single, double, or triple lumen.
The catheter may be inserted peripherally and threaded through the basilic or cephalic vein into the superior vena cava, inserted centrally through the internal jugular or subclavian veins, or surgically tunneled through subcutaneous tissue. With multilumen catheters, more than one medication can be administered at the same time without incompatibility problems, and only one insertion site is present.
Tunneled central venous catheters
- A more permanent type of catheter, such as the Hickman, Broviac, or Groshong catheter, is used for long-term IV therapy.
- The catheter may be single lumen or multilumen.
- The catheter is inserted in the operating room, and the catheter is threaded into the lower part of the vena cava at the entrance of the right atrium.
- The catheter is fitted with an intermittent infusion device to allow access as needed and to keep the system closed and intact.
- Patency is maintained by flushing with a diluted heparin solution or normal saline solution, depending on the type of catheter, per agency policy.
Vascular access ports (implantable port)
- Surgically implanted under the skin, ports such as a Port-a-Cath, Mediport, or Infusaport are used for long-term administration of repeated IV therapy.
- For access, the port requires palpation and injection through the skin into the self-sealing port with a noncoring needle, such as a Huber-point needle.
- Patency is maintained by periodic flushing with a diluted heparin solution as prescribed and as per agency policy.
- The catheter is used for long-term IV therapy, frequently in the home.
- The basilic vein usually is used, but the median cubital and cephalic veins in the antecubital area also can be used.
- The catheter is threaded so that the catheter tip may terminate in the subclavian vein or superior vena cava.
- A small amount of bleeding may occur at the time of insertion and may continue for 24 hours, but bleeding thereafter is not expected.
- Phlebitis is a common complication.
- Insertion is below the heart level; therefore air embolism is not common.