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Installation of Central Venous Catheters, Here's What You Need to Know

Central Venous Catheters (CVC) is a procedure such as infusion, but in large blood vessels. This procedure is carried out for long-term treatment that is risky if done through regular infusion, one of which is the administration of chemotherapy drugs. CVC installation is done by inserting a catheter into a large blood vessel, then directed towards the central vein that carries blood to the heart. CVC installation is performed on patients undergoing long-term treatment, because the catheter can last in the body for a long time. When undergoing long-term treatment, nutrition and medication intake cannot be given by infusion, because the infusion is only done for a few days and requires repeated needle replacement. This can damage the blood vessels if you continue. Based on the installation area and durability, CVC is divided into three types, namely:
  • PICC line: installed on the inner arm, and used for several weeks to several months.
  • Tunneled CVC: mounted on the chest, for use for months to years.
  • Subcutaneous port: implanted permanently in the chest, through a surgical procedure.

Indications for Central Venous Catheters

CVC installation is performed only on certain conditions, usually conditions that require access to blood vessels repeatedly or in the long term, as well as conditions that are at risk of injuring blood vessels if only through regular infusion. Some examples of these conditions are:
  • Blood samples will be taken many times.
  • Provision of chemotherapy drugs.
  • Dialysis or hemodialysis.
  • Blood transfusion.
  • Nutrition infusion.
  • Giving more than one type of drug at a time.
In addition, a CVC or central venous catheter is also installed when the doctor wants to check the pressure in the large blood vessels and as an entry point for the pacemaker. CVC is also often installed when someone is being treated in the ICU.

Central Venous Catheters Installation Warning

Patients with blood clotting disorders, for example due to low numbers of platelets (blood platelets), need to be careful because the installation of CVC risks causing bleeding. Installation of CVC in patients with sepsis can also make the infection worse. To be safe, discuss with the anesthesiologist first about the benefits and risks of CVC installation before this procedure is performed.

Before Installation of Central Venous Catheters

The doctor will do a blood test to make sure the patient does not experience blood clotting disorders. Then, patients will be asked to fast 4-6 hours before the installation of CVC.

Central Venous Catheters Installation Procedure

The doctor will clean and sterilize the area of ​​the skin where the catheter will be inserted, then inject a local anesthetic in that area. After the anesthetic has taken effect, the catheter will be inserted into a large blood vessel with the help of an ultrasound so that the catheter is not missed. Then the catheter will be stuck to the skin by stitching or gluing with special glue. If the catheter has been installed, the area where the catheter is inserted will again be cleaned and covered with sterile gauze, while the outer end of the catheter will be connected with an IV tube connected to the drug to be given. The outer end of the catheter can also be covered with sterile gauze when not in use. Before the catheter is used, the doctor will do an examination with X-rays to ensure the position of the catheter is right. This aims to prevent drugs from entering the wrong blood vessels.

After Installation of Central Venous Catheters

The following things need to be considered after undergoing CVC installation, especially if the CVC is still installed when the patient returns from the hospital:
  • The area used for catheter placement will be painful for 1-2 weeks, but this is quite normal.
  • Always wash your hands before touching the outside of the catheter, and always cover the area with a sterile bandage.
  • Make sure the tip of the catheter stays dry to prevent infection, and cover with water if you want to shower.
  • Change the bandage once a week, and replace immediately when the bandage is wet or dirty. The nurse will teach you how to replace the bandage properly.
  • Rinse the connector every day to prevent blood clots, by injecting blood-thinning drugs, such as heparin.
  • Make a reminder so you don't forget to change the bandage or replace the catheter when it's near the time specified.
  • Don't do sports that involve physical contact, such as soccer.

Risks and Complications of Installing Central Venous Catheters

Although it is rare, CVC installation can cause a number of complications. Complications can occur due to errors when installing CVC, or due to poor catheter care. Some of these complications are:
  • Blockage at the end of the catheter.
  • The catheter is detached from its position.
  • Blood clotting.
  • Bruising, bleeding, or infection in the area attached to the catheter.
  • Heart rhythm disorders, but only temporary.
  • Fluid retention in the chest cavity.

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