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Central Venous Catheter Insertion and Maintenance

Introduction

 

Due to their size and location, CVCs confer a much greater risk for bloodstream infection (BSI) than simple peripheral intravenous lines.  When a BSI occurs in a critically ill patient, the additional costs and the risk of death can be extraordinary.     

 

In most cases, episodes of catheter-related bacteremia cannot be traced back to one specific cause.  Rather, these infections are viewed as resulting from the cumulative exposure to a series of known potential risk factors.  These risk factors can be categorized according to the two phases of catheter care: insertion and daily managementThis tutorial will discuss the most important of these risk factors, with a special emphasis on ways that providers can minimize the risks inherent to the insertion phase

 

This website is intended for nurses and physicians working at Vanderbilt University Medical Center. Although individual facilities may differ, the topics outlined in this tutorial are universal and apply to most general critical care settings. Whenever possible, the guidelines in this tutorial are supported by expert recommendations in the published literature.  Of course, providers will ultimately need to make treatment decisions based on their own clinical judgment and individual patient characteristics.

 

 

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Abbreviations

BSI = bloodstream infection

CVC = central venous catheter

ICU = intensive care unit

PICC = peripherally inserted central catheter

Central venous catheters (CVCs) are a commonly used modality throughout the medical center and especially in the intensive care units, serving a vital role in the management of critically ill patients.  By definition, these devices involve placement of a large-bore catheter into one of the body’s main central veins.  Typical sites include the internal jugular, subclavian, and femoral veins.  Although indications vary among critically ill patients, these catheters are usually placed for vasopressor and medication administration, large-volume infusions, phlebotomy, or hemodynamic monitoring. Various CVC devices are available, including introducers, multi-lumen catheters, PICC lines, and hemodialysis catheters.  

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