Central Venous

Access &
Catheters
A Central Venous Catheter (CVC) is an
indwelling  intravenous device that is
inserted into a vein of  the central
vasculature.
 Difficult Peripheral Vascular Access

Volume Loading

USES
 Provision of Caustic Medications or Solutions

 Central Venous Pressure Monitoring

Repeated Blood Sampling

Introduction of Pacemakers or Pulmonary Artery  Catheters

For Hemodialysis
• Non-tunneled central
catheters
• Tunneled central
catheters
• Peripherally inserted
central catheters
(PICC)
Types Of
• Implantable ports
Central
Venous
Catheters
•Single & multi-lumen
catheters are available
in all catheter types
•Open–ended
• The catheter is open at the distal
tip
• The catheter requires clamping
before entry into the  system
• Clamps are
usually built
into the
catheter 
Requires
periodic
flushing
•Closed-ended
• A valve is present at
the tip of the catheter
or at the hub of the
catheter
•   Clamping is not
required as the valve is
closed except during
infusion or aspiration
Non Tunnelled
Catheters
Single or multiple lumens
Flow varies depending on size and
Iis  Inserted percutaneously
Internal jugular
vein  Subclavian
vein  Femoral vein
 Post-Catheter Placement

• Aspirate blood • Flush with saline •     Secure catheter • Cover with sterile • Obtain chest x-ray
from Aspirate
each port  or sterile
Flushwater  with sutures
Secure dressing
Cover for IJ and SC lines
Obtain
Tunnelled
Catheters
 • Single or multiple lumens 
• Used for long term therapy
•   Inserted surgically
• Small Dacron cuff sits in  subcutaneous tunnel facilitates
anchoring of the catheter  through granulation and acts as
a barrier to infection
Peripherally
Inserted Central 
Catheters
• Silicone or polyuretha
ne  
• Single or multi-
lumen    BASILIC
• Approximately 40-
60 cm long  CEPHALIC
• Used for intermediate to long term
therapy  Inserted percutaneously

*The tip rests in the superior vena cava at the cavo-atrial junction.
IMPLANTABLE
VENOUS ACCESS
DEVICE
(IVAD)
•long-term (months to years) single or dual
chamber a “port” surgically implanted in
the subcutaneous  tissue, usually in the
upper chest
•Single or double lumen.
•Each chamber must be managed
separately.
 • A non-coring point needle is
required to access  the device
• Unused port is flushed every 28
days with  Heparin solution
 Complications
Associated With
Central Venous
Catheters
Complica
tion rate
depends
on
 Si
t
e
 Patient factors (illnesses, variations in
anatomy)
   Operator skill and experience.
 Acute complications
Cardiac Dysrhythmias

Haematoma formation

Mechanical injury to nearby structures

Malposition  Lost Guide-wire

Air embolus  
 Air embolism
- Deadly complication associated with
CVC’s  

S/S
o Respiratory changes: sudden shortness of
breath,  cyanosis
o CVS changes: sudden onset of chest pain,
↑HR,↓BP
o CNS changes: altered neurological signs,
dizziness,  confusion, loss of Consciousness
Management
Left lateral decubitus with head low Position (Durant 
maneuver and Trendelenburg position)
Clamp the Central Venous
Catheter  100% O2
Direct removal of air from the venous circulation by 
aspiration from a central venous catheter in the right
atrium may be attempted
 To Ensure the lumen is clamped prior to opening
the system
minimize
the
chance of
air
entering
the Position the patient so that the insertion site is
system: at or below the level of the heart during
insertion and removal of catheter
Chronic complications
Infections

Catheter fragmentation

Non-function/Blockage

Thrombosis/Thromboembolism
 Infections
•Most frequent and
serious complications. 

Types
• Local infection –
Cellulitis
• Central Line-
Associated
Bloodstream
Infections  (CLABSI)
 Hand hygiene

EVIDENCE
BASED Maximal sterile barriers
PRACTICE
TO Chlorhexidine for skin asepsis
REDUCE
CLABSIs
Avoid femoral lines

Avoid/remove unnecessary lines

HEMODIALYSIS 
ACCESS
 VASCULAR ACCESS
DEVICES

HD
ACCESS  AV FISTULA 

AV GRAFT 
 Tunneled or Non- Tunneled 

Vascular
Access Immediate access to the patient’s circulation for
acute hemodialysis

Devices
Done when the catheter is going to be in place
for long term
TEMPORARY
ACCESS

JUGULAR

SUBCLAVIAN

FEMORAL
 Internal Jugular vein
NOT  the same side as
a planned or maturing
upper limb fistula 

Subclavian vein should be

AVOIDED because damage
to it may preclude
an arteriovenous fistula in
that arm

ALERT!!! 
 AV FISTULA

AV GRAFT PERMANENT
 ACCESS
PERMANENT CATHETER
ATERIOVENOUS
FISTULA (AVF)
• The preferred method of permanent vascular access for
dialysis 
• This access will need time (2 to 3 months) to “mature”
before it can be used
• This access has the longest useful life
Complications of AV fistula

■ Failure to mature
■ Stenosis/thrombosis
■ Aneurysm/pseudoaneurysm
■ Infection
■ Venous hypertension
■ Steal phenomenon- distal tissue ischemia
■ High output CF
■ lshcemic monomelic neuropathy
ATERIOVENOUS
GRAFT (AVG)
• can be created by subcutaneously interposing a synthetic
graft material between an artery and vein.
• created when the patient’s vessels are not suitable for
creation of an AVF
COMPLICATIONS OF AVG

Stenosis
Infection
Thrombosis
 PERMANENT
CATHETER/
TUNNELED CATHETER
PERMCATH COMPLICATION

 Arterial puncture
 Cardiac arrhythmias
 Air embolism 
 Bleeding
 Cardiac tamponade 
• A permacath is a name for a tunneled hemodialysis
catheter
• Tunneled dialysis catheters are generally double-lumen
catheters.
• These catheters are blunt, soft, and more flexible than
non-tunneled catheters