Central Venous Catheterization

Question 1

When is central venous access indicated?

Answer 1

When peripheral veins are inaccessible, for administration of potent vasoactive drugs such as norepinephrine or dopamine, when irritating or hypertonic solutions such as potassium chloride or parenteral alimentation are infused, when incompatible medications musty be infused through a multilumen catheter, when acute or subacute hemodialysis or hemofiltration is needed., or for hemodynamic monitoring or transvenous cardiac pacing.

Question 2

What is the complication rate of central venous catheters?

Answer 2

Approx. 15%

Question 3

When should someone seek help with CVL placement?

Answer 3

After 3 attempts

Question 4

T or F: Because CVC may be lifesaving, there are no absolute contraindications.

Answer 4

True

Question 5

Which site is least appropriate for the patient with a bleeding diathesis?

Answer 5

Subclavian site

Question 6

Where should you not place a catheter?

Answer 6

Through the site of infection or cutaneous burn.

Question 7

When should you not use the femoral vein?

Answer 7

When you have penetrating abdominal trauma or known inferior vena caval disruption.

Question 8

T or F: The number of catheter lumens does affect complication rate.

Answer 8

False. The number of catheter lumens does not affect the complication rate.

Question 9

Which catheters are useful for day to day use?

Answer 9

Triple or quadruple lumen catheters are extremely useful in the day to day care of critically ill patients. However, because of relatively small individual lumen diameter and long catheter length (>20-30 cm), resistance to flow is high, making these catheters less than ideal for rapid fluid infusion. Larger, shorter catheters are more conducive to rapid fluid administration. An 8.5 Fr introducer sheath is commonly used for this purpose.

Question 10

US guided CVC in what site has been associated with an increased success rate, decreased mechanical complications, and more rapid catheter placement?

Answer 10

Internal Jugular

Question 11

According to this study, what was the optimal catheter insertion depth for an adult of average size?

Answer 11

16.5 cm

Question 12

Where should the tip of the catheter rest?

Answer 12

Just above the junction of the superior vena cava and the right atrium. This position is approx. the second intercostal space.

Question 13

T or F: Redirection of the needle midcourse is strongly discouraged and may be associated with tissue laceration.

Answer 13

True

Question 14

When placing the guidewire, should resistance be met?

Answer 14

No minimal to no resistance should be met.

Question 15

When placing a subclavian or IJ CVC, a chest xray is obtained next for what reason?

Answer 15

To document proper catheter position and to check for potential complications such as pneumothorax.

Question 16

What should you do when disconnecting a catheter hub?

Answer 16

Care should be taken to occlude intravascular catheter hubs whenever they are disconnected.

Question 17

Which side is preferred when placing an IJ?

Answer 17

The right IJ vein is often preferred because of the relatively straight pathway to the superior vena cava.

Question 18

Where is the carotid artery compared to the IJ?

Answer 18

The carotid artery is medial and deep to the IJ.

Question 19

Where does the femoral vein lie?

Answer 19

The femoral vein lies approx. 1 cm medial to the femoral artery and runs in a parallel direction.

Question 20

What are the most common mechanical complications of CVC?

Answer 20

Arterial puncture, hematoma, and pneumothorax.

Question 21

Which site is more commonly associated with arterial puncture?

Answer 21

IJ

Question 22

Which site is more commonly associated with pneumothorax and hemothorax?

Answer 22

Subclavian

Question 23

What are the mechanical complications of femoral vein cannulation?

Answer 23

Arterial puncture, hematoma, and the possibility of arteriovenous fistula development.

Question 24

Which site is associated with fewer catheter-related infection?

Answer 24

The use of the subclavian site is associated with fewer catheter-related infections than the IJ or femoral sites making it the preferred site in many patients.

Question 25

Antibiotic ointments should or should not be used on CVL insertion sites?

Answer 25

Application of antibiotic ointment at the site of skin puncture has been show to increase the rate of fungal colonization and promote growth of antibiotic-resistant bacteria. Antibiotic ointments should therefore not be used.

Question 26

What is the commonly most contaminated site of a CVL?

Answer 26

The catheter hubs. Care should be taken to access a catheter hub no more often than absolutely necessary. When accessed, strict sterile technique should be followed. Antiseptic coated hubs have been shown to decrease the risk of catheter-related infections.

Question 27

Should you exchange a CVL over a guidewire?

Answer 27

No, Routine catheter exchange over a guidewire is NOT recommended. Routine central catheter changes are not warranted. In all cases, CVCs should be removed as soon as they are no longer needed.