Central venous and arterial lines are often necessary components of medical care. Central venous lines are usually indicated for administering irritants, vesicants, or vasopressors. Sometimes a central venous line is necessary for long-term access, renal replacement therapy, rapid administration of fluids, invasive hemodynamic monitoring, or the inability to obtain other IV access.
The first type of central venous access device is a PICC line. The IV catheter is inserted into a peripheral line, usually in the upper arm. PICC lines are commonly inserted for patients needing long-term access, such as chemotherapy. Though effective, complications of PICC lines include occlusion, hematomas, and infection. The next type includes tunneled and non-tunneled catheters. Though they are similar in design and function, they are used for different purposes. A tunneled catheter has both an entry site and an exit site, which are used for longer purposes. Non-tunneled catheters are for temporary use, like standard IV therapy or labs. Non-tunneled catheters do not require an incision and are usually used for two weeks or less. Totally implantable ports are also used for long-term purposes. Impregnated and coated catheters, coated with antibiotics, antimicrobials, or antimycotics, exist to decrease the accumulation and growth of bacteria and reduce catheter-related infections.
No matter which type of catheter is implanted, specific steps must be taken to complete the process properly. A CVAD with the smallest catheter and least amount of lumens should be used; these choices help to limit complications. An ultrasound should be used to insert a CVAD to reduce complications. Some common complications associated with CVAD include arrhythmias, arterial puncture, hematomas, hemothorax, lacerations, malposition, nerve injury, and pulmonary complications. Those are complications associated with insertion; there are post-insertion complications that should also be looked for. The most common type of post-insertion complication is a CLABSI. It can occur due to poor hand hygiene of the person inserting the catheter or contamination after insertion. Another complication is an air embolism, which occurs when air leaks into the bloodstream. Air embolisms can be diagnosed with an EKG, x-ray, CT scan, or, if needed, transthoracic echocardiography. Patients with air embolisms require immediate interventions such as hemodynamic support, oxygen, supportive positioning, and, worst-case scenario, CPR.
During insertion, damage is possible, which may result in catheter migration. A CVAD tip can migrate at any time after insertion. Other serious complications include a DVT, which can consist of symptoms of edema and/or pain in the chest, neck, or an extremity, erythema and/or numbness in an extremity, and difficulty moving the extremities and/or the neck. It can progress to a pulmonary embolism, evidenced by chest pain, diaphoresis, dyspnea, pleuritic pain, and tachycardia.
There are specific complications related to the catheter, including infiltration, extravasation, phlebitis, and occlusion. Both infiltration and extravasation result when fluid leaks into the surrounding tissue. Excavation occurs with vesicants and can result in increased harm, such as necrosis and tissue loss. Phlebitis results in inflammation of the vessel and can be grouped into different diagnoses, such as chemical or mechanical phlebitis. Occlusion results when something blocks the line and can also be divided into different diagnosis categories, such as chemical or mechanical occlusion.
Nursing care is pertinent, no matter if the patient has a CVAD or arterial line. Specific nursing care tasks include 1) assessment of the infusion system, 2) assessment of the insertion site, 3) dressing changes, 4) flushing and locking, and 5) observing for complications. The infusion system and the assessment site deserve routine monitoring and assessment for complications. Dressing changes should be performed as scheduled, such as every seven days, or as needed, such as when the dressing feels "boggy." Flushing, locking, and disinfecting ports require special steps and approaches.
Nursing care also means that complications should be prevented at all costs. Each complication requires different steps to prevent them. Central line infections require adequate hygiene and disinfection, and air embolisms require maintaining the integrity of the infusion system.
Central venous and arterial lines should be removed as soon as possible. Removal of catheters requires specific steps to ensure the catheter remains intact and the procedure goes smoothly. Orders should always be checked, and the facility's policies and procedures should always be followed. There are pros and cons related to the insertion and use of these devices; it depends on the patient and their situation. Regardless, safety measures must be followed.