A central venous access, or central line (CL), is a device inserted through a vein with the catheter tip positioned in a central vein, typically the superior vena cava or the caval atrial junction. It provides reliable access to the central venous system, and its placement is verified by radiographic studies during and after insertion. For oncology patients, it facilitates the administration of chemotherapy, intravenous fluids, medications, blood products, and parenteral nutrition as required. Additionally, it enables the collection of repeated blood samples with minimal discomfort for the patient. Central lines are also utilized for the harvesting and infusion of stem cells during bone marrow transplants.
Types
A catheter can be designated by the type of vessel it occupies (e.g., peripheral venous, central venous, or arterial); its intended duration (e.g., temporary or short-term versus permanent or long-term); its site of insertion (e.g., subclavian, internal jugular, peripheral, and peripherally inserted central catheter [PICC]); its pathway from skin to vessel (e.g., tunnelled versus non-tunnelled).
Most frequent types of CL used in oncology patients include peripherally inserted central catheters (PICCs), non-cuffed central venous catheters, long term tunnelled (LTS) catheters, skin tunnelled catheters and implanted ports.
Catheters Used for Venous Access
Care and Management of Central Lines
- Routine administration of systemic antimicrobial prophylaxis before insertion or during use of CVC to prevent catheter colonization or CLABSI is not recommended.
- Hand hygiene should be performed before and after palpating catheter insertion sites as well as before and after inserting, accessing, or dressing a CL.
- Wear sterile gloves when accessing and changing the dressing on CVC.
- Prepare clean skin with a >0.5% chlorhexidine preparation with alcohol before accessing CVC and during dressing changes. 70% alcohol can be used as alternative.
- Use either sterile gauze or sterile, transparent dressing to cover the catheter site.
- Replace transparent dressings used on implanted CVC sites no more than once per week.
- Replace catheter site dressing if the dressing becomes damp, loosened, or visibly soiled.
Catheter site inspection
There should be documented daily observation of the site for signs of infection or any other complication through an intact dressing on a regular basis. Monitor the catheter sites visually when changing the dressing or by palpation. If patients have tenderness at the insertion site, fever without obvious source, or other signs or symptoms suggesting local or systemic infection, the dressing should be removed to allow complete examination of the site.
Catheter access and cleaning site
Use aseptic technique and swab ports or hub with 2% chlorhexidine gluconate in 70% alcohol prior to accessing the CL for administering fluids or medications or withdrawing blood. Injection caps must be changed weekly. Port needles must be changed every 7 days.
Removal
CL should be removed as soon as they are no longer required; the necessity should be reviewed on a regular basis.
Routine catheter replacement is not recommended, and the catheter should only be changed when clinically indicated. Do not remove CVC on the basis of fever alone.
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