Central Venous Catheters

Question 1

What are the indications for central venous catheterization

Answer 1

1. Emergency venous access (failed peripheral venous access)
2. Administration of irritant substances
   - Vasoactive agents
   - Chemotherapy
   - TPN
3. CVP monitoring
4. ScvO2 monitoring/sampling
5. Renal Raplacement Therapy
6. Plasmapharesis/apharesis
7. Transvenous pacing

Question 2

What is a RICC line

Answer 2

Rapid infusion catheter

- Guidewire and dilator - sited via existing cannula

Question 3

Are CVL preferred for rapid fluid resuscitation

Answer 3

No

• Large bore peripheral IV
• RICC lines
• IO

Question 4

What are contraindications to CVP insertion

Answer 4

1. Coagulopathy
2. Respiratory Failure
3. Raised ICP (cannot tilt head down)

CAN USE FEMORAL APPROACH IN ALL ABOVE SITUATIONS

4. Obstructed vein (thrombus/tumour)
5. Overlying skin infection/burn or other disease process
6. Haemorrhage from target vessel
7. Unco-operative patient

Question 5

Classify and list the complications of central venous catheter placement

Answer 5

Immediate

1. Pneumothorax highest for supraclavicular approach)
2. Failure to locate vein
3. Accidental arterial puncture
4. Haemothorax
5. Haematoma
6. Arrythmia
7. Thoracic duct injury
8. Guide wire embolus
9. Air embolus

Early

1. Haemopericardium and tamponade
2. Pneumothorax
3. Catheter blockage
4. Chylothorax
5. Catheter knots

Late

1. Infection (no difference of incidence regardless of site: IJ/SC/Femoral)
2. Catheter fracture
3. Vascular erosion
4. Vessel stenosis
5. Thrombosis
6. Osteomyelitis of clavicle