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General Practice 2023

Central venous catheter (CVC): what é, what it is for and care

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Central venous catheter (CVC): what é, what it is for and care
Central venous catheter (CVC): what é, what it is for and care

Central venous catheterization, also known as CVC, is a medical procedure performed to facilitate the treatment of some patients, especially in situations such as the need for infusion of large volumes of liquids into the bloodstream, use of venous access for long periods, for better hemodynamic monitoring, as well as for blood infusion or parenteral nutrition, for example, when safer access to blood vessels is required.

Central venous catheters are longer and wider than common peripheral catheters used in veins in places such as the arm, and are designed to be inserted into large veins in the body, such as the subclavian, located in the chest, the jugular, located in the neck, or the femoral, located in the inguinal region.

Generally, this procedure is usually indicated in intensive care environments (ICU) or in emergency situations, and must be performed by the doctor, following a technique that requires surgical material and sterile equipment. After being placed, nursing care is required to observe and prevent complications such as infections or bleeding.

What is it for

The main indications for central venous access include:

  • Facilitate the maintenance of a venous access for long periods, avoiding the performance of multiple punctures;
  • Infusing large amounts of liquids or medications, which are not supported by common peripheral venous accesses;
  • Administer medications that can cause irritation when extravasation occurs from a peripheral venous access, such as vasopressors or hypertonic solutions of sodium and calcium bicarbonate;
  • Allow hemodynamic monitoring, such as measuring central venous pressure and collecting blood samples;
  • Use hemodialysis, in emergency situations or when the arteriovenous fistula has not yet been installed. Understand how hemodialysis is performed and when it is indicated;
  • Perform blood or blood components transfusion;
  • Facilitate chemotherapy treatment;
  • Allow parenteral nutrition when feeding through the gastrointestinal tract is not possible.

Performing central venous access should take some care to reduce the risk of complications. Thus, this procedure is not indicated in cases of infection or deformities of the site to be punctured, changes in blood clotting or when there are serious risks of bleeding, except in special situations indicated by the doctor.

How it's done

To perform central venous catheterization, it is necessary to position the person who is usually lying on the stretcher. Then, the doctor will identify the exact puncture site, and asepsis the region and the skin around it, eliminating foci of infection.

In addition, the doctor and staff must have carefully washed their hands and be wearing equipment that reduces the risk of infection, such as sterile gloves, mask, cap, surgical gown and sterile drapes.

The most used technique for performing central venous catheterization is called the Seldinger technique. To perform it, in addition to the protective equipment, the bag and equipment of serum, anesthetic, sterile gauze, scalpel and the central catheter kit, which contains a needle, guide wire, dilator and intravenous catheter, must be used as materials. of needle and thread to secure the catheter to the skin.

Currently, some physicians also choose to use ultrasound to guide catheter insertion and reduce the risk of complications.

It is also important to remember that, as it is an invasive procedure, it is necessary to inform and obtain the patient's consent for its performance, except in cases of emergencies or imminent risk of death, when communication is not possible.

Types of central venous access

Central venous catheterization can be performed in 3 ways, according to the vein chosen to be punctured:

  • Subclavian vein;
  • Internal jugular vein;
  • Femoral vein.

The choice of type of venous access is made by the physician according to the patient's experience, preference and characteristics, and all techniques are effective, and have advantages and disadvantages. For example, in patients who have had a chest trauma or who need cardiopulmonary resuscitation, femoral vein puncture is more indicated, while accesses through the jugular or subclavian veins have a lower chance of contamination.

Check out other types of catheterization that may be needed.

General care with the central catheter

Normally, the central venous catheter is used only in a hospital environment, as it needs to be properly taken care of, to avoid the entry of microorganisms into the body, which can cause a serious infection and put life at risk.

Thus, the CVC is usually taken care of by the nurse, who should have generic care such as:

  • Flush the catheter with saline, to prevent it from getting clogged with clots, for example;
  • Change the external dressing, especially if you have some type of secretion;

During any care for the central venous catheter, it is important to always wash your hands beforehand and use a sterile technique, that is, the CVC must be manipulated using a sterile field, as well as sterile gloves, even if it is just to administer some kind of medication.

Possible complications

Central venous access can cause some complications such as bleeding, bruising, infection, lung perforation, arrhythmia or venous thrombosis.

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