Chronic Central Venous Catheterization

Chronic Central Venous Catheterization – General Information

• The measurement of the quantity of fluid a patient needs and the pressure level inside the vessels
• The delivery of big quantities of blood or fluid in the body in a short time, especially in urgent cases, such as a shock.
• The administration of drugs directly in the body through the veins.
• The administration of special supplements and nutrition when the body can not offer them.
• The analysis of blood samples, which must be taken more than once a day

This procedure has become more and more frequent during the last decade and nowadays, doctors insert about 10 million of such tubes each year. However, Chronic Central Venous Catheterization presents a lot of side effects, which are expensive to handle and dangerous for the sufferers. These complications are divided in three categories: mechanical, infectious and thrombotic ones.

Chronic Central Venous Catheterization – Symptoms

• Pain during the insertion of the tube: the feeling of discomfort may appear because of the needle stick; in order to prevent this, doctors usually use a local anesthetic. However, the pain and discomfort disappear after the tube is completely inserted.
• Collapsed lung: this organ is located to the most common areas in which the tube is inserted: the chest and the neck. If the tube is not placed correctly it can touch the lung and perforate its surface, causing a collapse. If this happens, the doctor should place another tube in order to remove the air which leaks from the lung. This complication could become even more dangerous if the patient is connected to a breathing machine and, in such cases, it can lead to death.
• Bleeding: if this complication appears in the case of small veins, it does not receive much attention as it cures on its own. But if an artery is touched during the Chronic Central Venous Catheterization, the blood could even fill the chest and cause death.   
• Infections: these complications are the result of improper hygiene. 

Chronic Central Venous Catheterization – Treatment

• Preparation: the tubes and any other instruments which will be used during the procedure must be sterile and the doctor should create a sterile-barrier area; they must wear a sterile mask, sterile gloves, a sterile cap, a sterile gown and a sterile drape. All these measures reduce the risk for the patient to experience any infections. When the Chronic Central Venous Catheterization begins, the patient’s skin must be cleaned using a chlorhexidine solution.
• Experience: the risk of the appearance of certain side effects and other complications is reduced when the doctor has a greater experience and he has performed a large number of this kind of procedures. In extreme conditions, when the doctor who performs the insertion of the tube can not introduce it after three attempts, he should give up and call a more experienced specialist. In such cases, the possibility of mechanical complications is six times higher than at the first attempt.
• Ultrasound guidance: this is an important factor during the Chronic Central Venous Catheterization and, during the last years, it had been promoted as an important method in order to reduce the risks and complications associated with the procedure. The ultrasounds are used to determinate the exact position of the vein and to measure how deep beneath the skin is it placed. After that, the doctors use ultrasound visualization to insert the needle and move it to the vein. The usage of this technique reduces the number of failures, the mechanical complications and the time necessary to perform the procedure. On the other hand, this method does not prove that efficient in the case of sub-clavian venous insertion. In addition, in order to obtain benefic results, the doctors should benefit from adequate training.   
• Arterial puncture recognition and air embolism prevention: in what concerns a patient with a normal level of oxygen tension in the arteries and a normal blood pressure to arterial puncture is easy to identify, just by analyzing the color of the blood and its flow into the syringe. This measures give important information whether to insert the tube in the vein or in the artery. However, the arterial or venous pressure must be permanently analyzed.

The air embolism appears when a tube is open to room air and the pressure which results pulls air into the veins. This is a serious complication and even a small quantity of air can result in a life-threatening situation. In order to prevent this kind of complications, after Chronic Central Venous Catheterization the tube must be occluded permanently.