Dr.

KAMRAN NAWAZ
PG Trainee in Anaesthesia
department.
CENTRAL VENOUS
CATHETERIZATION
It is a procedure of inserting catheter
into venous circulation, advancing its
distal orifice immediately adjacent to or
at junction of superior vena cava &
right atrium
 INDICATIONS
Guiding fluid replacement.
 Evaluating cardiac functions.
 Providing access for;
 aspiration of air emboli during neuro surgical procedures
 Drug infusion, blood & fluid infusion
 Introducing Pulmonary artery catheter
 Blood sampling
 Transvenous pacemaker
 Phlebotomy site in pulmonary Edema
 Measurment of cv oxygen saturation.
► Non Operative Indication:
 Hyperalimentation
 Temporary hemodialysis
 Long term chemotherapy
 Frequent therapeutic plasma phresis
 Contra Indication
► Absolute C/I:
 In presence of severe coagulopathy
 Thrombocytopenia
Relative C/I
 Presence of Ipsilateral AV fistula for Hemodialysis
 Infection at chosen site
 Venous thrombosis at chosen site
Presence of IVC filter
 Difficult anatomical conditions e.g. Large goiter, neck tumors
 Renal cell tumor extending into Rt atrium.
 Vegetations of tricuspid valve.
 Basic Features
► Composition:
These are made of polymers impregnated with
barium or tungsten salts to enhance radiopacity.
Catheter design for short term use or made of poly
urethane. For prolong use they are of Silicon
polymer.
►Length:
Single lumen radiopaque CVC with length of
32cm, 45cm, 70cm. Permanent length marking at
5cm intervals with 1,2 or 3 infusion channels.
 TYPES OF CATHETER
► Single lumen catheter
► Multi lumen catheter
► Heparin bonded catheter
► Anti microbial impregnated, chlorhexidine-
silver sulfadiazine coated catheter has 1 wk
antimicrobial activity. Minocycline &rifampin
coated catheter has 4 wks antimicrobial
activity.
Size Chart for Vascular Catheters
French Gauge Inner Outer
Size Diameter Diameter
1 27 0.1mm 0.4mm
2 23 0.3mm 0.6mm
3 20 0.5mm 0.9mm
4 18 0.6mm 1.2mm
5 16 0.7mm 1.7mm
7 13 1.3mm 2.4mm
9 11 1.6mm 3.2mm
 Preparation & Procedure
► Informed consent.
► Proper positioning,monitoring equipment.
► Hand washing with soap, sterile gloves, mask,gown, sterile drapes.
Site is decontaminated with antiseptic agent(chlorhexidine preferred
b/c of prolonged activity of > 6 hrs)
Venous access site;
► Subclavian vein
► Internal, external jugular vein
► Femoral vein
► Cephalic , basilic vein
if pt is on ventilator;
Dec tidal volume.
Dec. PEEP
GIVE 100% OXYGEN.
Internal Jugular Central Approach
Femoral Approach
 Comparison of CVC Insertion
Sites: Risk for Complications

Subclavian IJ Femoral EJ

Pneumothorax Moderate Low 0 0

Arterial puncture Low Moderate High 0

Malposition Moderate Low 0 Mod

Thrombosis Low Moderate High ?

Infection Low Moderate High ?

All complications Moderate Moderate High Low

Ease of insertion Moderate High High Low

 Routine catheter care
► Protective dressings(sterile gauze pads,
adhesive, semi permeable dressing)
► Flushing catheter with heparinized fluids e.g
N/S with heparin (10-1000 u/ml).
► Alternative to heparin saline can be used.
 Replacing cv catheter
► If purulent drainage from catheter insertion
site.
► When catheter is suspected as a source of
sepsis & pt has prosthetic valve,
immunocompromised.
► If it is placed in emergency without aseptic
technique.
 Normal CVP waveform with cardiac
cycle
► A-wave; atrial systole
► C-wave;closure of tricuspid
valve
► X-descent; fall in atrial
pressure during ventricular
systole.
► V-wave; atrial filling
against closed tricuspid
valve.
► Y-descent; opening of
tricuspid valve.
 CVP Measurement
► Method A; CVP measured by using simple manometer.a
vertical tube is filled with saline from i.v fluid bag via a
three way tap. 3 way tap is then rotated so that column of
saline is attached to cv cannula & level of saline allowed to
fall until it equilibrates with the venous pressure.If the
base of column has been previously aligned with mid
axillary line, then heiget of column can be read directly to
give CVP.
► Method B; catheter is attached to a pressure transducer
that converts pressure transmitted via catheter into
electrical signal, thus displayed on a real-time display
screen (1mmHg = 1.3cm of water).
CVP Measurement by Using a
Manometer
 Complications
► Pneumothorax, hemothorax,infusion hydrothorax.
► Damage to brachial plexus.
► Phrenic nerve injury.
► Thoracic duct injury.
► Arterial injury d/t incorrect puncture technique.
► Haematoma at puncture site.
► Incorrect intra cardiac positioning with cardiac arrythmias.
► Danger of atrial rupture.
► Development of endocarditis d/t irritation.
► Catheter induced thrombosis, thromboembolism.
► Thrombophlebitis of SVC.catheter sepsis.
 CVC: Summary

► Learn proper technique for various insertion sites.

► Avoid / early recognition of complications
► Practice good infection prevention technique
» Maximum barrier precautions
» Chlorhexidine prep
» Subclavian site
» Remove CVC as soon as possible
» Consider antimicrobial-impregnated catheters
Thank You…