Overview of Care of a Central Line
Central venous catheters, or CVCs, are often used in various medical units like intensive care, dialysis, and cancer treatment centers. These tubes are inserted into a large vein in your neck, chest, or groin to deliver treatments such as fluids, medications, nutrition, or to carry out dialysis and monitor heart activity. However, having a CVC can increase your risk of developing blood clots, blockages, and infections by about 200% compared to patients who have smaller catheters inserted into the veins of the arms or hands.
Infections from CVCs are more common than any other infection you can get while receiving medical care. They account for about 33,000 deaths each year. These infections can also lead to more health complications, increase the chances of death, extend hospital stays, increase the cost of healthcare, and require extra tests and antibiotics. If a patient gets a bloodstream infection from a CVC, they might need to stay in the hospital for up to three weeks longer, costing on average an additional $33,000.
The Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Centers for Disease Control and Prevention (CDC) have published guidelines for how to use CVCs. These recommendations are based on the best available evidence and are intended to help healthcare providers prevent infections associated with central lines.
Anatomy and Physiology of Care of a Central Line
A Central Venous Catheter (CVC) is a tube that doctors put into a large vein in your neck, chest or groin to give you medicine or fluid. This can be put in three different places: the internal jugular vein (in your neck), the subclavian vein (under your collarbone), and the femoral vein (in your groin). Each location comes with its own pros and cons, and the choice often depends on the specific circumstances.
All three methods involve making a small hole in the skin, creating a pathway through the skin and muscle, and inserting the catheter into a large vein near the heart (vena cava). The doctor performing this procedure needs to have a good understanding of the body’s structure, both by looking at the surface and using an ultrasound.
The chance of getting an infection from this procedure can vary based on where the catheter is placed. For instance, there are usually fewer infections when the catheter is placed in the subclavian vein underneath the collarbone. However, there is a higher chance of infection if the catheter is placed in the femoral vein in the groin.
Why do People Need Care of a Central Line
A central line is a type of catheter that doctors insert into a large vein in your neck, chest, or groin to give medication or fluids, draw blood, or perform medical tests. There are several reasons why you might need one:
The first is when you need certain types of drugs. Some medicines, like chemotherapy drugs for cancer treatment, medicine to raise blood pressure (vasopressors), or solutions with a high sugar or salt concentration, are too strong for the smaller veins in your arms or hands. These drugs can harm your peripheral veins, the veins farther from the heart, so they’re given through a central line instead.
You might also need a central line if you need medicine or nutrition over a long time. For example, if you need constant antibiotics or parenteral nutrition, a way of giving nutrients through a vein, a central line can make this easier.
Sometimes, it’s hard for doctors to put a needle into a peripheral vein, perhaps because the person is overweight, their veins are damaged from previous injections, or they are agitated. In these situations, a central line is often more practical.
Another reason for a central line is to monitor the condition of your heart and blood flow. Doctors can use it to measure the pressure in the large veins, the amount of oxygen in the blood, or to guide fluid treatments in conditions like heart failure or kidney disease.
Lastly, you may need a central line for specific treatments like dialysis (a treatment for kidney diseases), plasmapheresis (a procedure that filters the blood), and cardiac pacing (a procedure that helps regulate the heart rhythm).
After the central line is placed, healthcare providers will need to give it special care. This includes regular checks of the insertion site, daily monitoring of the line, and adjusting care as your condition changes. They will also adhere to clinical standards to ensure the central line is used properly.
One important part of caring for your central line is ensuring the area around it is always kept dry, clean, and free of bacteria.
When a Person Should Avoid Care of a Central Line
There are several reasons why a doctor might decide not to place a central line, or a catheter, into a patient’s vein. Some of these reasons need to be thought about when the catheter is being inserted, while others might come up during the patient’s ongoing care and treatment.
One reason might be that the patient has problems related to clots, valve or tumor issues (called ‘Embolic Issues’):
Existing clots in the central part of the circulation can be moved around when a catheter is inserted, leading to the possibility of a stroke.
Bacterial buildup on valves can be pushed around and lead to tissue death or more infections.
Heart tumors can break up easily or cause clots to form.
Another issue might be bleeding risk:
Patients with existing conditions affecting their blood might be prone to bleed excessively.
Previous injuries or operations at the insertion site can increase the possibility of an accidental puncture of an artery.
Certain medications impacting the body’s ability to form clots can increase bleeding risk too.
Infection is another major reason. If there’s an infection at the point where the catheter is supposed to be inserted, it’s completely unsafe to proceed. Doctors need to watch the inserted catheter site for symptoms of infection and treat it, usually by removing the catheter. Having a catheter can also increase the chances of an infection in the bloodstream. This happens because the biofilm (a kind of bacteria layer) can form on the catheter, which may need to be replaced more often.
Damage to the skin, due to radiation, pressure, or direct trauma, is another reason to avoid inserting the catheter at a particular site. In some cases, a damaged area caused by a previously inserted catheter, might not be usable for future catheter insertions. However, recent reviews suggest that having a catheter on one side does not necessarily mean that the vein on the same side can’t be used for another procedure like hemodialysis. This suggests that current or previous catheter placements are unlikely to be reasons not to use a particular vein, especially if there were no complications during the initial insertion.
Equipment used for Care of a Central Line
Every care should be taken to make sure the process of inserting the catheter and looking after it is done cleanly to prevent any possible infections. This means washing hands properly and using sterilised equipment.
Any procedure that exposes the dressings of the catheter should start with cleaning the skin. It has been observed that most infections connected to catheters are due to bacteria on the skin. However, using a skin cleaner which contains 2% of a sanitizing agent called chlorhexidine, can cut down this risk significantly.
After the catheter’s been put in, we don’t usually recommend applying antibacterial creams onto the site. Though these creams can help decrease the chance of blood poisoning connected to the catheter, they’ve also been known to heighten the risk of bacterial infections that are resistant to antibiotics and fungal infections.
It’s important to dress the catheter properly to keep the area clean and dry. Polyurethane film dressings are the most used kind – they stick to the skin and are clear, so you can check the catheter site for signs of infection or other issues without taking off the dressing. However, some research has shown that these dressings can trap moisture, leading to more skin bacteria and infections. These studies suggest dressings that allow the skin to breathe are a better option.
Parts of the catheter where you connect tubes to give fluids (known as “access hubs”) can be another potential source of infection. You must make sure to clean these hubs well and avoid touching them to reduce the risk of infection. While certain improvements, like wrapping these hubs with a type of antibiotic gauze or using a specially designed hub, have been introduced, they aren’t in widespread use as yet.
In the intensive care setting, fluids are routinely given into the catheter to keep it from getting blocked and to help measure the pressure in the central veins. This helps doctors to know if the catheter is still in the right place.
Who is needed to perform Care of a Central Line?
This advice is important for doctors, nurses, and other medical personnel who work in places like the Intensive Care Unit (ICU, where very sick people are treated), Operating Room (OR, where operations are done), dialysis units (where people with kidney problems are treated), and chemotherapy units (where cancer treatment is given). These are places where patients often stay for a long time or come regularly for treatment with special tubes, called catheters, put into their bodies.
The UK National Institute for Clinical Excellence, a health organization that gives advice to doctors and nurses, says that anyone who looks after a patient with a catheter must be properly trained. They must know how to use the catheter carefully to prevent infections, and they must always follow the guidelines.
Preparing for Care of a Central Line
As mentioned before, it’s crucial to clean the skin properly before a medical procedure. This could involve gathering specific materials used for routine cleansing. This should be done in a proper medical setting, like an intensive care unit (ICU) or operating room.
Before starting these preparations, if the patient is awake, they should be fully informed about what will happen and give their agreement. The healthcare team will then change any dressings or perform other care methods using a sterile technique and without touching the wound directly. It’s important not to leave the spot uncovered for too long to prevent germs from getting in.
How is Care of a Central Line performed
Taking care of a central line, a type of medical device located around the area of your chest, involves regular checks and changes of its dressing (covering). Changing the dressing gives doctors the chance to closely inspect the device’s area and clean the surrounding skin. While there’s debate about how often this needs to be done, some research has suggested that changing the dressing and cleaning the skin with a medical soap called chlorhexidine every two days can be beneficial. However, changing it more often than this doesn’t seem to improve things.
Practicing regular hand hygiene, using sterile gloves, and wearing masks are crucial during dressing changes for both the medical professional and the patient. After removing the old dressing, fresh sterile gloves should be put on before applying the new one. If there’s a problem with central line-related bloodstream infections not decreasing in the particular hospital or clinic, a special sponge dressing soaked in chlorhexidine might be recommended.
Every time the central line is cared for, a careful check should be done to make sure nothing is amiss. This includes making sure the device that keeps the central line secure without the need for stitches is in place, noting the date when the dressing was last changed (which should be written on the dressing), and encouraging the patient to tell the healthcare provider if there’s any swelling or pain around the device.
Central line devices also need flushing every day. This act of cleaning the inside of the device with fluid is done to prevent blood clots from forming and to keep the device free of blood. Ideally, each part (also known as a lumen) should be flushed in the same order every time. Depending on the exact type of line device used, either a solution of heparin (a medicine that prevents clots) or a saline solution (sterile salt water) should be used for the flushing.
Possible Complications of Care of a Central Line
When installing a central line (a tube placed in a large vein to give fluids or medication), there could be complications right after the procedure. Some of these complications include a punctured lung (pneumothorax), damage to blood vessels (vascular perforation), and air bubbles in your veins (venous air embolism).
Other issues might show up a bit later. An example of this is an infection related to the central line, which affects around 5% of hospital patients in the United States. This can be a serious issue, and can lead to fatalities in 12% to 25% of the cases.
The central line could also stop working. This might happen due to an increase in resistance, blockage, patient’s position, or clumps of a protein called fibrin in the tube which obstruct the opening of the line. In such cases, doctors might use special drugs like alteplase to dissolve the blockage.
Other, less common, complications are line fracture due to high pressure, and a condition known as central venous thrombosis and stenosis. This happens when blood clots form, or when the vein narrows down due the line irritating it and causing an overgrowth of fibrous tissue inside the blood vessel.
What Else Should I Know About Care of a Central Line?
A central line is a tube that doctors put into a large vein in your neck, chest, or groin to give medication or fluids. It’s also called a central venous catheter. Caring for this central line is really important. If complications occur, it can cause a lot of health problems, extend your hospital stay, and slow down your recovery.
This tube needs special attention; more nursing time, inexpensive disposable items, and changes to monitoring practices. Although these things may add to the cost, they’re still much cheaper compared to the cost of treating an infection or complication related to the central line.
A rough estimate indicates that treating these complications can range anywhere from $3,700 to $39,000 in the USA and China, or around 8,810 euros in Europe. In contrast, using the right type of dressing (bandage) for the central line can save about £93 per patient in the UK, compared to the expected cost of dealing with infections and complications.
It’s also important to remember that these complications can affect your quality of life. They might have long-term effects on your health, limit your treatment options in the future, and increase your risk of other health problems. So, proper care of a central line can spare you such issues, speed up your recovery, and even save money.
