Central Venous Catheters

What is a central venous catheter?

A central venous catheter, or vascular access device (VAD), is a long, thin, flexible tube used to give medicines, fluids, nutrients, or blood products over a long period of time, usually several weeks or more. A catheter is often inserted in the arm or chest through the skin into a large vein. The catheter is threaded through this vein until it reaches a large vein near the heart.

A catheter may be inserted into the neck if it will be used only during a hospital stay.

What is a central venous catheter used for?

Central venous catheters are used to:

• Give long-term medicine treatment for pain, infection, cancer, or to supply nutrition. A central venous catheter can be left in place far longer than an intravenous catheter (IV), which gives medicines into a vein near the skin surface.
• Give medicines that affect the heart, especially if a quick response to the medicine is wanted.

What types of central venous catheters are there?

There are several types of central venous catheters.

• PICC line. A peripherally inserted central catheter, or PICC line (say "pick"), is a central venous catheter inserted into a vein in the arm rather than a vein in the neck or chest.
• Tunneled catheter. This type of catheter is surgically inserted into a vein in the neck or chest and passed under the skin. Only the end of the catheter is brought through the skin through which medicines can be given. Passing the catheter under the skin helps keep it in place better, lets you move around easier, and makes it less visible.
• Implanted port. This type is similar to a tunneled catheter but is left entirely under the skin. Medicines are injected through the skin into the catheter. Some implanted ports contain a small reservoir that can be refilled in the same way. After being filled, the reservoir slowly releases the medicine into the bloodstream. An implanted port is less obvious than a tunneled catheter and requires very little daily care. It has less impact on a person's activities than a PICC line or a tunneled catheter.

Can complications result from the use of a central venous catheter?

Possible complications from the use of a central venous catheter include:

• Bleeding, caused by inserting the catheter into the vein.
• Collapsed lung (pneumothorax). The risk of a collapsed lung varies with the skill of the person inserting the catheter and the site of placement. It is most likely to happen during placement of a catheter in the chest, although the risk is still small.
• Infection, requiring treatment with antibiotics or removal of the catheter.
• Blockage or kinking of the catheter. Regular flushing of the catheter helps reduce blockage. A kinked catheter must be repositioned or replaced.
• Pain. You may experience pain at the place where the catheter is inserted or where it lies under your skin.
• Shifting of the catheter. A catheter that has moved out of place can sometimes be repositioned. If repositioning does not work, it must be replaced.

• Pulmonary Embolism

Other Works Consulted

• Lutsi B, Buchman A (2007). Enteral and parenteral nutrition. In DC Dale, DD Federman, eds., ACP Medicine, section 4, chap. 13. New York: WebMD.