April 14, 2024
Central Venous Catheters

Central Venous Catheters: Different Types and their Uses

A central venous catheter, also known as a central line, is a long, thin, flexible tube placed through the skin and threaded into a large vein near the heart. Central venous catheters provide convenient access to a patient’s venous system for long term infusion therapy like frequent blood sampling, administration of medications, and blood transfusions. In this article, we will discuss the different types of central venous catheters and their primary uses in healthcare.

Tunneled Catheters
Tunneled catheters have an internal cuff which tunnels the catheter under the skin, decreasing the risk of infection and dislodgement. There are a few variations of tunneled catheters:

– Peripherally Inserted Central Catheters (PICCs): PICCs are inserted into an upper arm vein and guided into a large vein near the heart. They can remain in place for several weeks or months and are commonly used for long-term antibiotics or chemotherapy treatment. With the lowest risk of complications among central lines, PICCs are often the preferred choice when IV access is required for more than 6 weeks.

– Tunneled Hemodialysis Catheters: These Central Venous Catheters have two lumens to allow efficient hemodialysis and are tunneled under the chest wall for permanent access. They are typically placed in the internal jugular or femoral vein of patients with kidney failure who require routine dialysis treatment. Due to repeated use and longer dwell time, tunneled hemodialysis catheters have a higher risk of clotting or infection compared to PICCs.

Nontunneled Catheters
Nontunneled catheters do not have a cuff to anchor the catheter beneath the skin. Some common types are:

– Noncuffed Central Venous Catheters (CVCs): Also known as acute catheters, noncuffed CVCs are placed in the internal jugular, subclavian or femoral veins for short-term use of up to 20 days. They are appropriate for critically ill patients who require intensive care with frequent bloodwork and vasoactive medications that cannot be given peripherally. However, noncuffed CVCs pose a greater infection risk compared to tunneled catheters.

– Midline Catheters: A midline catheter is slightly longer than a regular peripheral IV catheter but does not enter the central circulation like a CVC. Placed in the basilic or cephalic veins of the upper arm, midline catheters can remain in situ for 4 to 6 weeks, bridging the gap between a peripheral IV and a central line for long-term antibiotic infusion. They are less likely to cause complications in comparison to CVCs.

Implantable Ports
An implantable port or port-a-cath is a totally implantable venous access device placed just under the skin, usually in the chest. It comprises a small reservoir connected to a catheter that terminates in a large vein. Ports are accessed through the skin using a non-coring Huber needle rather than an external catheter. This increases patient mobility and comfort while under long-term chemotherapy or requiring frequent transfusions and bloodwork exceeding 3 months. The risk of infection or dislodgement is very low with ports compared to other central access devices.

Catheter Selection
The type of central venous catheter chosen is based on the intended use, duration of IV therapy, patient-related factors like vessel size and compliance, and preference of the healthcare team. Tunneled cuffed catheters are preferred when long-term access exceeding 6 weeks is needed. Nontunneled catheters are suitable for short-term critical care. Implantable ports are ideal for chemotherapy regimens or frequent blood draws lasting several months. Selection involves weighing the risks and benefits of each device based on individual patient needs. Proper insertion and maintenance techniques also help mitigate catheter complications.

Conclusion
Central venous access devices play an important role in modern medicine by allowing safe and secure delivery of medications, fluids and blood products into the central circulation. Despite risks, central lines can significantly improve quality of life for patients requiring long-term intravenous therapy by avoiding repeated peripheral insertions. Understanding the characteristics of different catheter types enables healthcare teams to select the most appropriate central access option for each clinical situation.

Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it