Care of patient with CVC Petra Sedlarova, Renata Vytejckova, Jana Hermanova

Central venous access Access into blood stream via central vein The distal end of the catheter ends in superior vena cava

Historical milestones 1929 – Werner Forssmann – the first to insert CVC (Nobel prize 1956) 1950 – Aubaniac – first cannulation of subclavian vein 1953 – invention of Seldinger technique (trocar, guidewire, sheath) 70s of 20th century – development central venous catheter associated with parenteral nutrition The end of the 70s – clear guidelines on indication and contraindication of using CVC

Indications Serious condition with collapsed peripheral veins Severe edema of extremities Long term treatment Long term parenteral nutrition Administration of high osmolarity solutions Administration of vesicants CVP measurement Extracorporeal elimination methods

Contraindications Serious coagulopathy Patient’s refusal

Types of catheters Non-tunneled (short term) Tunneled (long term) Swan – Ganz Catheter for hemodialysis Tunneled (long term) Hickmann catheter Implantable venous port PICC

Swan - Ganz

Hickmann catheter

PICC

PORT

Insertion site: Superior vena cava Inferior vena cava Subclavian vein Internal jugular vein External jugular vein Basilic vein Cubital median vein Inferior vena cava Femoral vein

V. Jugularis interna

Material features Hydrophilic Smooth surface should prevent thrombus formation Anti infectious Silver coated ATB coated Silikon Vialon Polyurethan

Other classification Single lumen Multiple lumen

Catheter insertion Puncture technique most common Sterile procedure - set up sterile field, insertion kits are used Local anesthesia (1% trimekain, lidokain, EMLA), occasionally general anesthesia Peripheral venous catheter Informed consent Monitoring

Seldinger technique

Check correct placement By the length of the inserted catheter X ray Blood aspiration

Start treatment Only after the placement has been verified by X ray

Possible complications Pneumotorax Bleeding into mediastinum Puncture of a. subclavia Hemotorax Pulmonary embolism Infection Thrombosis Damage of the vein wall

Patogenesis of infections Intraluminal infection Extraluminal infection Endogenous infection

Factors contributing to infection Health condition of the patient Skin condition at the insertion site Location of insertion site

Contributing factors - location V. Femoralis Close to genitals Friction, movement V. jugularis Movement Hair, facial hair, airway Possible kinking

Infection signs Local – at the insertion site General – fever, malaise Suspect catheter infection - Draw blood cultures during fever

Preventive measures Aseptic approach during insertion and care Proper hand hygiene, gloves Minimize the number of lumens and connections Minimize the length of insertion Use safe connectors (luer) Proper location of insertion site

Care of the catheter Always sterile approach Secure the catheter (stitches, sterile strips) Sterile dressing Regular dressing changes Regular changes of the tubings Minimize the number of connections Maintain the patency Needleless connections Clave, Q-syte, Posiflow

Dressing changes Sterile equipment Gloves, face mask depending on the type of the catheter Alcohol desinfection Dressing according to the guidelines Transparent dressing Nontransparent dressing Assessment of the insertion site

Taking blood samples Syringe Vacuum system Procedure Stop all infusions Discard first 10 to 20 ml of blood Draw the samples Flush with NSS Possible complications

Removing catheter Sterile procedure Compression of the insertion site Cut off the distal end of the catheter, send to microbiology lab Monitor for bleeding