Central venous access is necessary for an increasing number of medical interventions. In United States intensive care units, over 5 million central venous catheters are inserted annually for rapid intravenous access and resuscitation. Over 200,000 patients annually are identified who require permanent pacemaker placement, and increasing numbers of cardiac ablations have been performed over time. In addition, over 80 percent of new hemodialysis patients are initiated with hemodialysis catheters, despite guidelines recommending early planning for arteriovenous access to minimize catheter use.

Central venous access complications significantly increase length of stay and health care costs and negatively impact quality-of-life. Many complications are preventable with improved training and meticulous technique, and growing awareness of these issues has led to even greater emphasis on addressing these deficiencies. Central venous access may be achieved from several access sites. The most frequently accessed sites are the internal jugular, subclavian, and femoral veins. For many years, these veins were accessed using familiarity with nearby anatomic structures (i.e, landmark techniques). However, this approach fails to account for body habitus, anatomic variations, or pathology in patients, possibly leading to higher complication rates even in well-versed hands. As an example, the internal jugular veins are typically 1 to 2 cm from the skin but may be markedly deeper in obese patients, increasing the risk of complications; these vessels may also be thrombosed (eg, oncology patients), making cannulation impossible and subjecting the patient to a needless and unsuccessful procedure.

Ultrasound-guided access has become the standard for venous access in most situations because of these shortcomings. Even a quick, single view can be useful; real-time ultrasound-guided access in either the transverse or longitudinal plane provides information that can reduce access-related complications .However, the utility of ultrasound depends on the skill of the operator and inherent properties of ultrasound waves. As an example, compared with experienced users, novices are not likely sufficiently proficient to fully benefit from ultrasound-guided access. Nevertheless, various studies suggest an approximately 50 percent reduction in complications for ultrasound-guided access compared with landmark techniques. Central venous access is necessary for an increasing number of medical interventions. In United States intensive care units, over 5 million central venous catheters are inserted annually for rapid intravenous access and resuscitation. Over 200,000 patients annually are identified who require permanent pacemaker placement, and increasing numbers of cardiac ablations have been performed over time. In addition, over 80 percent of new hemodialysis patients are initiated with hemodialysis catheters, despite guidelines recommending early planning for arteriovenous access to minimize catheter use.

During the CVC insertion procedure, a number of lung-related complications can occur, including:

Fluid can build-up of between the lining of your lungs and your chest cavity.

Injury can occur to your windpipe, or trachea.

Injury can occur to the laryngeal nerve, which controls your voice box.Air embolism, or a blockage of blood supply caused by air bubbles, can occur.Central venous line infections become established when a thin slimy film known as biofilm, collects on the internal and/or external surface of the catheter. The two most common bacteria, that make up a CVC-related biofilm are Staphylococcus aureus and Staphylococcus epidermidis. Both of these bacteria are commonly found on your skin’s surface.If it’s suspected that you might have a CVC infection, blood cultures will be drawn from separate sites and antibiotics will be prescribed. A CVC is not recommended for most people as a permanent method to provide dialysis access due to the potentially serious central venous catheter complications that can arise. However, for those needing immediate access, a CVC may be the best option-even if it’s just a temporary solution.

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Regards

Richard Potvin

Editorial Assistant

General Surgery: Open Access