Central Venous Catheters And Their Complications


 

Central venous catheters inserted into the subclavian vein or a more peripheral vein in the upper extremity are extremely useful more measuring central venous pressure (CVP) and for providing a conduit for the rapid infusion of fluid or chronic hyperalimentation.So that the CVP may be correctly measured, the catheter must be located within the true central venous system, beyond all the valves that interfere with direct transmission of right atrial pressure to the catheter.The optimal location is where the brachiocephalic veins join to form the superior vena cava (medial to the anterior portion of the first rib on chest radiographs) or within the superior vena cava itself.

Because up to one-third of CVP catheters are incorrectly placed at the time of initial insertion, correct positioning of the catheter should be confirmed by a chest radiograph.If the tip of the catheter is outside the central venous systems, the true CVP is not being measured.This can lead to serious complications if the patient’s intravascular blood volume is being ragulated on the basis of the erroneous CVP measurements.The most common abberant location of a CVP catheter is the internal jegular vein.CVP catheters that extend to the right atrium are associated with an increased risk of cardiac perforation by the catheter.Continued infusion of fluid through the catheter into the pericardial space following perforation can rapidly cause fatal cardiac temponade.Positioning of a CVP catheter in the right ventricle predisposes to cardiac arrhythmias because of irritation of the endocardium.Extension of the catheter into the hepatic veins may permit the infusion of potentially toxic substances (some antibiotics and hypertonic hyperlimentation solutions) directly in to the liver.Because CVP catheters may change position after initial placement because of such factors as patient motion or medical manipulation, periodic radiographic confirmation of the catheter position is often recommended.

The anatomy of the subclavian region may lead to complications when a central catheter is introduced via the subclavian vein.Because the pleure covering the apex of the lung lies just deep to the subclavian vein, a pneumothorax may develop.Since this may be difficult to detect clinically, a chest radiograph (if possible, with the patient in an upright position in expiration) should be obtained whenever insertion of a subclavian catheter has been attempted.Because there is a greater chance of perivascular CVP catheter placement with the subclavian approach than with peripheral insertion, another complication is ectopic infusion of fluid into the mediastinum or pleural space.The rapid development of mediastinal widening or pleural effusion after insertion of a subclavian catheter should suggest the diagnosis of ectopic infusion.Other complications include inadvertent puncture of the subclavian artery, air embolism, and injury to the phrenic nerve.

Catheter breakage and embolization can result from laceration of the catheter by the needle used to insert it, fracture at a point of stress, or detachment of the catheter from its hub.The catheter fragment may lodge in the vena cava, in the right side of the heart, or in the pulmonary artery, and result in thrombosis, infection, or perforation.

central venous catheter · central venous pressure · central venous line ·

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