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

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

3. 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

4. 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

5. Contraindications
Serious coagulopathy
Patient’s refusal

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

7. Swan - Ganz

8. Hickmann catheter

9. PICC

10. PORT

11. 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

14. V. Jugularis interna

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

16. Other classification
Single lumen
Multiple lumen

17. 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

18. Seldinger technique

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

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

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

24. Patogenesis of infections
Intraluminal infection
Extraluminal infection
Endogenous infection

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

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

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

29. 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

30. 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

33. 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

34. 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

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