Central Venous Catheter

Central venous catheters can be inserted into various body veins, whereby each access route has specific advantages and disadvantages. The most commonly used puncture sites or access points include

• Internal jugular vein: jugular catheter (iCath)
• Subclavian vein: subclavian catheter (sCath)

Other possible access routes are

• Vena basilica
• External jugular vein (eCath)
• brachiocephalic vein (vena anonyma)
• femoral vein (fCath)

Only rarely used:

• Cephalic vein
• brachial vein

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The choice of puncture site depends on various factors, including:

• Subsequent intended use (e.g. volume replacement, chemotherapy, parenteral nutrition).
• Condition of the patient (e.g. age, general condition, injuries)
• Conditions when placing the catheter (e.g. hospital - emergency, sterile - non-sterile, etc.)
• Experience of the attending physician
• Pressure conditions in the venous system

In the case of central venous catheters, the catheter may be positioned incorrectly or may turn over intravascularly. The catheter is then not positioned regularly in front of the right atrium, but in another vessel. In the case of a subclavian catheter, for example, there is a possibility that the catheter is mistakenly advanced into the jugular vein. A position that is too deep, e.g. in the right atrium or right ventricle, is also possible and undesirable.

To ensure a good catheter position, continuous monitoring is carried out during the procedure. For this purpose, an ECG is recorded between the catheter tip and a surface electrode. When the CVC is advanced close to the heart, the ECG changes in a characteristic way: If the tip of the wire is too close to or even in the right atrium, an exaggerated, pointed P wave appears on the ECG (similar to a spike during pacemaker stimulation). The catheter is then withdrawn until the P wave normalises.

This is usually followed by an X-ray check (chest X-ray). This also rules out a pneumothorax.

Furthermore, once the CVC has been inserted, blood can be taken from one of the legs and a blood gas analysis prepared. By analysing the pO₂, it is possible to differentiate between arterial and venous blood. If the pO₂ is elevated, a malposition in an arterial vessel can be assumed.

• Bleeding and haematoma
• Arterial malpuncture
• Infection - especially if located in the femoral vein, e.g. through exposure to faeces in patients with nappies. The other positions for catheter placement are clearly preferable here.
• Air embolism
• Nerve injuries
• Pneumothorax, haematothorax, infusion thorax, chylothorax
• thrombosis
• Cardiac arrhythmia

see also: central venipuncture, peripheral venipuncture, peripheral venous catheter