Central venous catheterization, also known as CVC, is a medical procedure performed to facilitate the treatment of some patients, especially in situations such as the need for infusion of large volumes of fluids in the bloodstream, use of venous access for long periods, for a better hemodynamic monitoring, as well as blood infusion or parenteral nutrition, for example, requiring safer access to blood vessels.
The central venous catheter is longer and wider than the common peripheral catheters used in the veins of places such as the arm, and are designed to be introduced into large veins of the body, such as the subclavian, located in the chest, the jugular, located in the neck, or the femoral, located in the inguinal region.
Generally, this procedure is usually indicated in intensive care environments (ICU) or in emergency situations, and must be done by the doctor, following a technique that requires surgical material and sterile equipment. After being placed, it is necessary to have nursing care to observe and prevent complications such as infections or bleeding.
What is it for
The main indications for central venous access include:
- Facilitate the maintenance of a venous access for long periods, avoiding multiple punctures;
- Infuse large quantities of liquids or medications, which are not supported by common peripheral venous accesses;
- Administer medications that can cause irritation when extravasation occurs from a peripheral venous access, such as vasopressors or hypertonic solutions of sodium and calcium bicarbonate;
- Allow hemodynamic monitoring, such as measuring central venous pressure and collecting blood samples;
- Performing hemodialysis, in urgent situations or when the arteriovenous fistula has not yet established itself. Understand how hemodialysis is done and when it is indicated ;
- Perform blood or blood components transfusion;
- Facilitate chemotherapy treatment;
- Allow parenteral nutrition when feeding through the gastrointestinal tract is not possible.
The performance of the central venous access must be careful to reduce the risk of complications. Thus, this procedure is not indicated in cases of infection or deformities of the site to be punctured, changes in blood clotting or when there are serious risks of bleeding, except in special situations indicated by the doctor.
How is done
To perform central venous catheterization, it is necessary to position the person, who is usually lying on the stretcher. Then, the doctor will identify the exact location of the puncture, asepsis of the region and the surrounding skin is performed, eliminating foci of infection.
In addition, the doctor and the team must have done a careful hand washing and be dressed with equipment that reduces the risk of infection, such as sterile gloves, mask, hat, surgical gown and sterile drapes.
The technique most used to perform central venous catheterization is called the Seldinger technique. To carry it out, in addition to the protective equipment, the bag and equipment of serum, anesthetic, sterile gauze, scalpel, and the central catheter kit, which contains needle, guidewire, dilator, and intravenous catheter, must be used as materials. needle and thread to attach the catheter to the skin.Surgical equipment introduction of the catheter into the vein
Currently, some doctors also choose to use ultrasound to guide the insertion of the catheter and reduce the risk of complications.
It is also important to remember that, as it is an invasive procedure, it is necessary to inform and obtain the patient’s consent for its performance, except in case of emergencies or imminent risk of death, when communication is not possible.
Types of central venous access
Central venous catheterization can be performed in 3 ways, according to the vein chosen to be punctured:
- Subclavian vein;
- Internal jugular vein;
- I saw femoral.
The choice of the type of venous access is made by the doctor according to the experience, preference and characteristics of the patient, all of which are effective and have advantages and disadvantages. For example, in patients who have had a thoracic trauma or in which cardiopulmonary resuscitation is required, puncture of the femoral vein is more indicated, while accesses through the jugular or subclavian veins are less likely to be contaminated.
General care of the central catheter
Normally, the central venous catheter is used only in a hospital environment, as it needs to be taken care of correctly, to prevent the entry of microorganisms in the copro, which can cause a serious infection and put life at risk.
Thus, the CVC is usually taken care of by the nurse, who must have generic care such as:
- Making flush the catheter with saline to avoid becoming clogged with clots, for example;
- Change the external dressing , especially if you have any type of secretion;
During any care for the central venous catheter, it is important to always wash your hands beforehand and use a sterile technique, that is, you must manipulate the CVC using a sterile field, as well as sterile gloves, even if it is just to administer some type medication.
Central venous access can cause some complications such as bleeding, bruising, infection, lung perforation, arrhythmia or venous thrombosis.