Central Venous Catheter is a catheter that ends in a large vein, either the Superior Vena Cava (SVC), which is just above the heart or the Inferior Vena Cava (IVC), which is just below the heart. Central Venous Catheters are also called Central Lines and Central Venous Access Devices. There are many other names for Central Lines, but all of them have their tips at either the SVC or the IVC. These catheters are commonly placed in the arm, neck, chest, or leg. Very often the location on the body where the catheter is placed will be its name. (i.e.Jugular Lines, Femoral Lines, PICC (peripheral) lines). Central Venous Catheter lines provide treatment options for medications that are hazardous for smaller veins, or the patient requires longer-term IV access that would be difficult to maintain with a basic IV or midline. The central line, having its tip located in the larger superior vena cava or inferior vena cava, allows for greater dilution of cytotoxic or chemically harsh solutions. Additionally, for some patients where obtaining blood necessary for treatment decisions by the physician is difficult, central lines provide a means to easily obtain blood samples from the patient’s veins. Finally, for critically ill patients needing rapid fluid resuscitation or dialysis, large bore Central Venous Catheters provide a reliable route to accomplish these treatment goals and requirements.
Central Venous Access Device
| CVAD
A Central Venous Access Device, often abbreviated as CVAD, is often ordered based on the patients’ needs both now and in the future. Advanced Vascular Access teams are important because they can provide the right type of access at the right time for the patient, avoiding the possibility of multiple procedures and possibly harming the patient with the incorrect CVAD. Standard PICC teams are often not able to provide the more advanced options of Internal Jugular, Axillary, or Mid-Thigh Femoral CVADs. Basic vascular access teams also cannot insert large bore and dialysis catheters, and this can often cause a delay in patient care. A Peripherally Inserted Central Catheter (PICC) is often ordered for patients needing central venous access because it is the “easiest” line to obtain in today’s health care settings. Very often patients have a medical history or condition in which a PICC line is contraindicated or not as favorable for the patient’s condition. In these situations, and when vascular access through the upper arm is restricted, the PICC is no longer clinically appropriate and another CVAD must be chosen. The Axillary Line, placed in the chest in the Axillary vein, provides an effective option when there is limited access to the upper arm either due to a contracted limb or poor skin integrity. Risks associated with certain breast cancer surgeries can also be avoided with this advanced option. When vascular access is contraindicated to the chest or arm areas possibly related to Deep Vein Thrombosis (DVT), Chronic Kidney Disease, or Upper Arm Cellulitis, the Internal Jugular Line, placed in the neck, is often an appropriate CVAD. Lastly, our specially placed Mid-Thigh Femoral line, which avoids the high bacterial counts of the inguinal fold (reducing risks of infection) can be successfully utilized in patients when upper torso placement is contraindicated such as Superior Vena Cava Syndrome (blocked SVC), a newly placed cardiac pacer/defibrillator, or infection/burns in the upper body. For additional flexibility, Central Venous Access Devices are available in single or multiple lumens, including double, triple, or even quadruple lumens. The appropriate device is selected based on the patient’s vascular access needs, and this helps a patient achieve a better outcome and return to health.
Central Venous Access Device placement is preferably placed utilizing ultrasound as a reliable way to visualize and guide the needle. Clinicians with ultrasound expertise that allows both vessel and needle visualization, enjoy a much-reduced incidence of complications and provide a clinically proven safer option for their patients. The presence of an ultrasound must be combined with expertise for both patient safety and to have success with “difficult” patients. Central Venous Catheter Devices are most commonly placed with either Seldinger or Modified Seldinger Technique. Central Venous Access Device insertion can be confirmed via Electrocardiogram (ECG) Tip Confirmation technology or traditional X-Ray. ECG, which requires additional training, eliminates additional x-ray and allows for more rapid use of the catheter if needed.
Central Venous Catheter Care
| Central Venous Catheter Nursing Care
Proper Central Venous Catheter Care is a critical part of line maintenance to help mitigate the risk of infection and other line complications, while also enabling the catheter to maintain patency (function). Central Venous Catheter Care includes changing the bandage (dressing), routine flushing (as well as after medication administration) of the catheter with saline, and changing the cap (IV connector) on the end of the catheter lumen. Complications like infection or lack of function could require the line to be removed before treatment is completed, possibly requiring a new line to complete therapy, increasing costs and delaying treatment. It has been demonstrated that Central Line Associated Bloodstream Infection (CLABSI) and Catheter Related Blood Stream Infection (CRBSI) risks are greatly reduced with the correct catheter care and maintenance program. A well-developed care and maintenance plan includes knowledge and training on flushing guidelines, troubleshooting sluggish catheters or catheters that do not give a blood return, determining and addressing incorrect catheter positioning, and assessing symptoms of CLABSIs. Other training includes how to develop and implement the Centers for Disease Control (CDC) recommended Central Line Care Bundles, select products for optimal Central Line Care, and how to reduce premature removal of catheters prior to therapy completion. This kind of training can be attained from Vascular Access Companies such as Vascular Wellness, and in the case of Vascular Wellness, can be customized to address specific concerns and conditions. Training from a specialized Vascular Access Company tends to be more effective as many times, the trainers are the actual, practicing nurses who place central lines regularly.
Central Venous Catheter Dialysis
| Dialysis Catheter Insertion
When a patient’s kidneys stop functioning or have reduced function, either due to an acute episode or a chronic condition, hemodialysis is often needed to replace the natural kidney function of removing impurities from the blood. One of the common ways to start this process is to place a large bore central venous catheter specifically designed to handle the large blood flow requirements of a dialysis machine. These catheters are often referred to as Vas-Caths and are normally placed in either the internal jugular vein or the femoral vein. These catheters are available as a dual lumen catheter specifically for dialysis, and also a triple lumen version which reserves two lumens for dialysis and a third lumen for other vascular access needs such as medication administration or blood sampling. Depending on the patient’s condition the Vas-Cath may allow for the normal kidney function to return, or the patient may need to transition to a more permanent type of dialysis access. Ideally, a patient will receive an AV Fistula or Graft but may require a “Perma-Cath” which is a type of catheter designed to remain in the patient for a longer period of time than a Vas-Cath. Occasionally a patient already has a more permanent type of access that fails and they, in turn, need a Vas-Cath placement to obtain hemodialysis as well.
Placement of these larger bore central lines requires a high level of skill and focus to have the best outcomes. Pristine sterile technique and expert-level needle and vein visualization allow these procedures to be done very safely at the bedside, avoiding the hazards of intra-hospital transport, and a reduced time to obtaining dialysis. Although very few Vascular Access Nurse Specialists are able to perform this procedure, Vascular Wellness prides itself on its outstanding safety record with no serious adverse outcomes in hundreds of placements of these catheters in patients. Proper insertion by skilled clinicians means less need for transfusion due to blood loss by inexperienced clinicians, better catheter performance due to correct positioning, and longer dwell times due to anatomical placement at the low jugular position, allowing for a cleaner, neater dressing.
Vascular Wellness has instituted a large bore line placement program including nurse placement or insertion of Vas-Caths for Dialysis and this program involves extensive training both in coursework and clinical training. Vascular Wellness care partners have seen the benefits of our clinicians placing Vas-Caths as patients are not delayed in obtaining the catheter, dialysis is often performed the same day as catheter order (a rarity in many facilities), and this service is available on weekends and holidays. Medical facilities can have cost savings from the reduced need to use more costly medical specialists as well as from the elimination of transportation expenses.
Vascular Access Specialists
| Vascular Wellness
Vascular Wellness is a team consisting of Vascular Access Specialists that have elevated the role of nurses in the placement of the Central Venous Access Device. Clinicians skilled in the insertion and placement of Central Venous Catheters have tremendously effective options when Midlines and PIVs are not clinically indicated. Vascular Wellness specializes in all aspects of CVAD placement including assessment, insertion, maintenance, difficult placements, and removal. Vascular Wellness clinicians are W2 employees who complete comprehensive training that can involve placing 50 to 100 lines per procedure type, follow best practices for line placement for vein preservation and to prevent side effects, and utilize the best equipment and supplies from Bard/BD, a leading supplier to hospitals. Vascular Wellness clinicians can place Ultrasound-Guided Extended Dwell PIVs, Midlines, and PICCs, and many clinicians can place advanced devices including Small Bore Central Catheter Lines (such as Internal Jugular Lines and Femoral Lines) and Large Bore Central Catheter Lines (such as Vas Caths for Dialysis and Quad Lumens). Vascular Wellness also provides vascular access training, infection control, and comprehensive administrative support including quality reports and detailed patient records for The Joint Commission surveyors. Vascular Wellness clinicians are Vascular Access Specialists.
To learn more about the care and maintenance of PICCs and Midlines, see our PICC and Midline Catheter Care page
If you require Vascular Access or want to learn more about our services, speak to the team at Vascular Wellness today. For the latest articles and insights, follow us on LinkedIn, Facebook, Twitter, YouTube, and Instagram.
Vascular Wellness Serves North Carolina, South Carolina, and Virginia and expanding to Georgia, Kentucky, Ohio, Tennessee, and West Virginia.
