Central venous catheter: How should the insertion site be selected?
Release date:
2023-09-25
Source:
Author:
1. How should the insertion site for a central venous catheter be selected? Currently, multiple guidelines and the Chinese Expert Consensus on Vascular Access for Hemodialysis recommend the following order of catheterization sites: right internal jugular vein, left internal jugular vein, right femoral vein, left femoral vein, and subclavian vein.
1. How should the insertion site for a central venous catheter be selected?
At present, multiple guidelines and the Chinese expert consensus on vascular access for hemodialysis recommend the following order of catheter placement: right internal jugular vein, left internal jugular vein, right femoral vein, left femoral vein, and subclavian vein.
2. How long can a central venous catheter typically remain in place?
In principle, non-tunneled venous catheters in the neck should not be left in place for more than 4 weeks; if prolonged placement beyond 4 weeks is anticipated, a tunneled catheter should be used. Non-tunneled femoral venous catheters should generally not exceed 1 week; however, in patients who are long-term bedridden, this duration may be extended to 2–4 weeks.
3. What are the complications of central venous catheterization?
Complications of central venous catheterization can be categorized into intraoperative and postoperative complications. Intraoperative complications include bleeding, local hematoma, pneumothorax, hemothorax, mediastinal hemorrhage, air embolism, and arrhythmias; femoral vein catheterization may also lead to retroperitoneal hematoma, arteriovenous fistula, and aneurysm, among other complications. Once intraoperative complications arise, they must be promptly managed; otherwise, they can readily become life‑threatening.
Intraoperative complications are often related to procedural technique; striving to improve technical skills and employing ultrasound guidance can help reduce such complications. Postoperative complications, primarily caused by the prolonged indwelling of the catheter in the vessel, are difficult to avoid and include catheter dysfunction, central venous stenosis, thrombosis, and catheter‑related infections.
4. Why is it contraindicated to place a central venous catheter for hemodialysis in the subclavian vein?
Subclavian venous catheterization carries a high incidence of subclavian vein stenosis, with reported rates as high as 30% to 50%, which can directly compromise the establishment of a brachiocephalic arteriovenous fistula in the ipsilateral limb. Therefore, subclavian venous catheterization should be avoided in patients who may require an arteriovenous fistula in the future.
Latest News
NEWS INFORMATION
