• Central Line Inserted Central Catheter

    Definition

    A central catheter is a long, thin tube that is inserted into a large vein. A central catheter is used to deliver medicine, nutrition, IV fluids, and chemotherapy .
    There are different types of central catheters, including:
    • Peripherally inserted central catheter (PICC line)—The catheter is threaded through a vein in the arm until it reaches the larger vein close to the heart.
    • Non-tunneled central catheter—It is inserted in a large vein in the neck or leg; the tube end is outside of the skin.
    • Tunneled central catheter—It is inserted in the neck vein and “tunneled” under the skin. The end of the catheter is sticking out from under the skin, usually below the collarbone.
    • Port catheter—It is inserted in a shoulder or neck vein. The port is under the skin, and the catheter is tunneled into the central vein. The port is accessed by putting a needle through the skin directly into the port.
    Veins in the Arm
    IMAGE
    A peripherally inserted central catheter is threaded through a vein in the arm.
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    Central catheters are inserted when patients need:
    • Long-term medicine or fluids
    • Chemotherapy
    • Nutrition, but cannot get it through the digestive system
    • Repeated blood draws
    • Blood transfusions
    • IV medicine when arm veins are difficult to access
    • Dialysis
    A central catheter is commonly inserted by special types of doctors called interventional radiologists or vascular surgeons . Once the line is in, it can be used for weeks to months.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have a central catheter inserted, your doctor will review a list of possible complications, which may include:
    • Bloodstream infection —occurs when bacteria enters the bloodstream through or around the central line
    • Bleeding
    • Collapsed lung
    • Heart arrhythmias (changes in the way your heart beats)
    • Nerve injury
    • An air bubble or part of the catheter blocks a blood vessel, causing chest pain, shortness of breath, dizziness, and rapid heart beat
    • Blood clots in the vein or on the catheter, potentially blocking the vein
    Factors that may increase the risk of complications include:
    • Smoking
    • Veins that are difficult to reach
    • Blood clots
    • Obesity
    • Broken bones
    • Infection
    • Poor blood circulation
    • Clotting or bleeding tendencies
    Discuss these risks with your doctor before your central catheter is inserted.

    What to Expect

    Prior to Procedure

      At your appointment before the procedure:
      • You may have a blood draw to check how well your blood clots.
      • Your doctor may ask if you have any allergies.
    • Arrange for a ride home after the procedure.
    • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs (eg, aspirin )
      • Blood thinners, like warfarin (Coumadin)
      • Clopidogrel (Plavix)
    • If you think you may be pregnant, tell your doctor before the procedure.

    Anesthesia

    You will be given a local anesthetic at the insertion area. Depending on where your central catheter is placed, you may receive a sedative through an IV.

    Description of the Procedure

    This procedure may be done while you are in the hospital as part of your treatment or in an outpatient setting. If you are already in the hospital for another reason, this procedure is unlikely to extend your stay.
    Having a catheter inserted increases your risk of a bloodstream infection. The hospital staff will begin the procedure by taking the following steps to reduce this risk:
    • Carefully choose a safe site to insert the catheter.
    • Thoroughly wash their hands or use a hand sanitizer.
    • Wear surgical gowns, masks, gloves, and hair coverings.
    • Clean your skin with an antiseptic.
    • Place a sterile sheet over you.
    The next steps may differ depending on the type of catheter and the insertion site. In general, the staff will:
    • Give you an anesthetic.
    • Make a small incision.
    • Use an x-ray or ultrasound to guide a wire into the vein.
    • Before inserting the catheter, cut it to the correct length. Flush the catheter with saline (salt water).
    • Insert the catheter using the guide wire. Then, remove the wire.
    • Use sutures or tape to secure the catheter line. Place caps on the end of the catheter.
    • Cover the insertion site with a bandage. Write the date of the insertion on or near the bandage.
    If you have a port inserted, a small pocket for the port will be created under your skin. The incision will be closed over the pocket, usually with dissolving sutures.

    Immediately After Procedure

    You will be checked for bleeding, drainage, and bruising at the insertion site.

    How Long Will It Take?

    30-45 minutes

    How Much Will It Hurt?

    During the procedure, you will not feel any pain because of the anesthetic. There may be mild discomfort at the insertion site after the procedure.

    Average Hospital Stay

    This procedure is most commonly done in a hospital setting because it is needed for your treatment. The length of stay will depend on the reason you need the central catheter. If you are an outpatient receiving treatment through your central catheter, you may be sent home the same day as the procedure.

    Post-procedure Care

    At the Hospital
    After the procedure, the staff may provide the following care to help you recover:
    • Do an x-ray to make sure your catheter is in the correct position.
    • Continue to check the insertion site for bleeding.
    • Give you medicines, fluids, or nutrition through the catheter.
    • Flush catheter ports to prevent blood clots.
    • Take steps to reduce your risk of infection by:
      • Thoroughly washing their hands and wearing gloves before touching the catheter or changing the bandage
      • Using an antiseptic to clean the catheter opening
      • Taking precautions when handling medicine, fluid, or nutrition that will be delivered through the catheter
      • Watching you closely for signs of infections—These signs include fever, chills, and problems at the insertion site (eg, redness, swelling, drainage).
      • Not allowing visitors in your hospital room when the bandage is being changed
      • Keeping the catheter in place only as long as it is needed
    There are also steps that you can take to reduce your risk of infection:
    • Ask the staff to take every precaution to prevent an infection.
    • Tell the staff right away if the bandage needs to be changed or if the site is red or sore.
    • Ask everyone entering your hospital room to wash their hands. Do not allow visitors to touch your catheter.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • Keep your insertion site clean, dry, and covered with a bandage. Follow your doctor's instructions for changing the bandage.
    • Before touching the catheter, wash your hands or use a hand sanitizer. Wear gloves when touching the area.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water. If allowed by your doctor, cover the bandage with plastic when showering.
    • Do not swim or bathe while your central line is in.
    • Avoid lifting or any kind of activity that may loosen the central line.
    • Do not allow anyone to touch the catheter or the tube.
    • Check the insertion site daily for signs of infection (eg, redness, pain).
    • Learn how to take care of your catheter.
    • Flush the line with saline or heparin as directed.
    • Take medicine as directed.

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • Signs of infection—fever and chills, redness or swelling at the insertion site
    • Pain at the insertion site
    • Drainage or leakage from the catheter
    • Trouble flushing or inserting fluids into the catheter
    • Catheter loosens or falls out
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Cancer Society http://cancer.org

    Vascular Access Management http://picclinenursing.com/

    CANADIAN RESOURCES

    The College of Family Physicians of Canada http://www.cfpc.ca/

    Health Canada http://www.hc-sc.gc.ca/index-eng.php

    References

    Central venous catheter. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 1, 2009. Accessed September 14, 2009.

    FAQs: Catheter-associated bloodstream infections. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/BSI%5Flargertext.pdf . Accessed January 12, 2010.

    Neff D. Preventing infections during surgery: what hospital staff and patients can do. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated January 2010. Accessed January 12, 2010.

    Smith N, Walsh K. Central venous catheter care. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=860 . Published May 8, 2009. Accessed September 24, 2009.

    Vascular access procedures. Radiological Society of North America website. Available at: http://www.radiologyinfo.org/en/info.cfm?pg=vasc%5Faccess . Accessed September 24, 2009.

    Walsh K. Peripherally inserted central catheter (PICC) care: insertion techniques. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=860 . Published August 28, 2009. Accessed September 14, 2009.

    6/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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