Central Venous Access

Question 1

Where does a central venous catheter get placed?

Answer 1

the superior vena cava.

Question 2

What can central lines be inserted?

Answer 2

subclavian, internal jugular, femoral

PICC - Antecubital (cephalic or basilar)

Question 3

What are some complications of central venous access?

Answer 3

Thrombus/Embolism

Infection

Pneumo - mostly from subclavian insertion

Question 4

Describe the A, C, and V waves in relation to a central venous catheter (either in superior vena cava or right atrium).

Answer 4

A wave - RA systole - bigger wave because of dramatic increase in pressure due to atrial contraction

C wave - tricuspid valve bulging - this is due to the increase in pressure in the right venticle during ventricular systole, occurs after A wave because venticular systole occurs after atrial systole. The tricuspid valve bulges into the right atrium during ventricular systole causing a slight increase in pressure in the atrium, this is why the wave is smaller.

V wave - RA filling - This wave comes after the C wave because passive atrial filling comes after ventricular systole. This wave is bigger than the C wave because this process accounts for a majority of the filling of the larger ventricles.

Question 5

`Why dont you see a C wave when the catheter is inserted all the way to a distal portion of the pulmonary artery (PAWP or PAOP measurements)?

Answer 5

C wave doesnt occur because bulging of the mitral valve during left ventricular systole is hard to read from so far away, especially due to the small increase in pressure it produces.