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Central venous catheter

Central venous catheter
Diagram showing a central line CRUK 059.svg

Diagram showing a tunneled central line inserted into the right subclavian vein.

In medicine, a central venous catheter (CVC), also known as central linecentral venous line or central venous access catheter, is a catheter placed into a large vein in the neck (internal jugular vein), chest(subclavian vein or axillary vein) or groin (femoral vein). It is used to administer medication or fluids, obtain blood tests (specifically the "central venous oxygen saturation"), and measure central venous pressure.

Medical uses

Central line equipment

Non-tunneled central venous catheter.

dialysis two-lumen catheter inserted on the person's left side. Scars at the base of the neck indicate the insertion point into the left jugular vein.

Reasons for the use of central lines include:[1]

Central venous catheters usually remain in place for a longer period of time than other venous access devices, especially when the reason for their use is longstanding (such as total parenteral nutrition in a chronically ill patient). For such indications, a Hickman line, a PICC line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a porte d'entrée (place of entry) for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci.[citation needed]

Bloodstream infections[edit]

All catheters can introduce bacteria into the bloodstream, but CVCs are known for occasionally causing Staphylococcus aureusand Staphylococcus epidermidis sepsis. The problem of central line-associated bloodstream infections (CLABSI) has gained increasing attention in recent years.[3] They cause a great deal of morbidity and deaths, and increase health care costs. Historically, a small number of CVC infections were considered an acceptable risk of placing central lines. However, the seminal work by Dr. Peter Pronovost at Johns Hopkins Hospital turned that perspective on its head. From 2003 to 2006, the Agency for Healthcare Research and Quality provided $300,000 a year to fund the Comprehensive Unit-Based Safety Program (CUSP) that helped participating hospitals in Michigan lower CLABSIs. By 2012, the project had become a $20 million nationwide initiative.[4]Additionally, the Institute for Healthcare Improvement (IHI) has done a tremendous amount of work in improving hospitals' focus on central line-associated bloodstream infections (CLABSI), and is working to decrease the incidence of this particular complication among US hospitals.

The National Patient Safety Goals NPSGs and specifically NSPG 7.04 address how to decrease infections.[5] The NSPG 7.04 has 13 elements of performance to decrease CLABSIs.

The 13 Elements of Performance (EPs):

  • EP 1 & 2 deal with educating staff and patients about Central Vascular Catheters and their potential complications

  • EP 3 specifically directs facilities to implement policies and practices to reduce CLABSI

  • EP 4 & 5 are about how to perform surveillance for Central-Line Associated Bloodstream Infections (CLABSIs)

  • EP 6-13:

- Institute for Healthcare Improvement (IHI) bundle

  • 1. Hand Hygiene

  • 2. Full body drape

  • 3. Chlorhexidine gluconate skin anti-septic

  • 4. Selection of Optimal site for Central venus Catheter (CVC)

  • 5. Daily review of ongoing need for CVC

- Disinfection of intravenous access ports before use

National Patient Safety Goals require documentation of a checklist for CVC insertion and Disinfection of intravenous (IV) access ports before use (scrub the hub). Some literature has suggested the use of a safer vascular access route - such as intraosseous (IO) vascular access - when central lines are not absolutely necessary (such as when central lines are being placed solely for vascular access). Infection risks were initially thought to be less in jugular lines, but this only seems to be the case if the patient is obese.[6]

If a patient with a central line develops signs of infection, blood cultures are taken from both the catheter and from a vein elsewhere in the body. If the culture from the central line grows bacteria much earlier (>2 hours) than the other site, the line is the likely source of the infection. Quantitative blood culture is even more accurate, but this is not widely available.[7]

Generally, antibiotics are used, and occasionally the catheter will have to be removed. In the case of bacteremia from Staphylococcus aureus, removing the catheter without administering antibiotics is not adequate as 38% of such patients may still develop endocarditis.[8]

In a clinical practice guideline, the American Centers for Disease Control and Prevention recommends against routine culturing of central venous lines upon their removal.[9] The guideline makes a number of further recommendations to prevent line infections.[9]

To prevent infection, stringent cleaning of the catheter insertion site is advised. Povidone-iodine solution is often used for such cleaning, but chlorhexidineappears to be twice as effective as iodine.[10] Routine replacement of lines makes no difference in preventing infection.[11]


CVCs have been mistakenly inserted into the carotid artery or vertebral artery when placed in the neck, and into the common femoral artery when placed in the groin. The tip of the catheter can also be misdirected into the contralateral (other side) subclavian vein in the neck, rather than into the superior vena cava.


File:Internal jugular vein puncture with the aid of ultrasound.ogv

Video of an ultrasound-assisted central line insertion through the internal jugular vein

Triple lumen in jugular vein

A central venous catheter secured to the skin with suture

Chest x-ray with catheter in the right subclavian vein


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