By the end of the module, you will be able to learn: Types of Dialysis Access Define what is Central Venous Catheter Identify the most common complications of CVC Familiarise the use the MR VICTOR Types of Catheter Locking Solution

1. Addenbrooke’s Hospital I Rosie Hospital
Central Venous Catheter
as access for Haemodialysis
Regin Lagaac
Vascular Access
Renal
Cambridge University Hospitals NHS Foundation Trust

2. This module is essential for all renal haemodialysis nurses and should
be completed every year.
Please allow 20 minutes to complete the course and extra time to
access and read the resources available.
When all slides have been visited you will be asked to take an
evaluation of learning quiz which is evidence for your completion of the
course.

3. By the end of the module, you will be able to:
• Types of Dialysis Access
• Define what is Central Venous Catheter
• Identify the most common complications of CVC
• Familiarise the use the MR VICTOR
• Types of Catheter Locking Solution
There now follows a short learning evaluation of 15 questions
80% pass mark is required to complete the training. If this is not reached,
you can review the learning material and retake the assessment.

4. Types of Dialysis Access
• Arterio Venous Fistula (AVF)
• Arterio Venous Graft (AVG)
• Permanent or Tunnelled Line
• Tenckhoff Catheter
Photo:azuravascularcare.com

5. What is Central Venous Catheter?
A long, y-shaped, hollow plastic
tube that is inserted though one of
the central veins found in the neck,
chest or groin.
The catheter tip is within the
upper part of the right atrium (RA)

6. The 5 Most Common Central Venous Catheter Complications
• Damage to central veins
• Pulmonary, or lung, complications
• Cardiac, or heart, complications
• Device dysfunction
• Infection

7. Damage to Central Veins
• Damage to central veins, including injury, bleeding and hematoma (a
swelling that consists of clotted blood), can occur during CVC
placement.
• Studies shows that puncture of a vein occurs in 4.2–9.3% of catheter
placements. Injury to the vein occurs more often when the catheter is
inserted into the femoral vein found in the leg, and less often when
it’s placed in the internal jugular vein.
Bowdle, A. (2014) Vascular complications of central venous catheter placement: Evidence-based methods for prevention and treatment. Journal of Cardiothorac
Vascular Anesthesia 28:358–68.
Kornbau, C., Lee, K. C, Hughes, G. D., and Firstenberg, M.S. (2015) Central line complications. International Journal of Critical Illness and Injury Science 5(3): 170–178.

8. Pulmonary Complications
• Fluid can build-up of between the lining of your lungs and your chest
cavity.
• Injury can occur to your windpipe, or trachea.
• Injury can occur to the laryngeal nerve, which controls your voice box.
• Air embolism, or a blockage of blood supply caused by air bubbles,
can occur

9. Device Dysfunction
Cracking or breaking
Thrombosis or a blood clot
Obstruction of the catheter

10. Infection
Central venous line infections become established when a thin slimy film known as
biofilm, collects on the internal and/or external surface of the catheter.
The two most common bacteria, that make up a CVC-related biofilm are
Staphylococcus aureus and Staphylococcus epidermidis. Both of these bacteria are
commonly found on your skin’s surface.
Central Venous Catheter should be avoided as a form of haemodialysis access due to
high rate of infection.
Kornbau, C., Lee, K. C, Hughes, G. D., and Firstenberg, M.S. (2015) Central line complications. International Journal of Critical Illness and Injury Science 5(3): 170–178.

11. MR V I C T O R
Multi
Racial
Visual
Inspection
Catheter
Tool
Observation
Record
Department of Health, 2007; Pratt et al, 2007; UK Renal Registry, 2006; Kidney Disease Outcomes Quality Initiative, 2002

12. Types of Catheter Locking solutions
Citralock 46.7% trisodium citrate = causes anticoagulation. Prevents the
activation of clotting cofactors, factor X, and prothrombin, and the
ultimate formation of fibrin. Antimicrobial effect and a reduction of
bioilm formation.
Taurolock = The lock solution contains (cyclo)-taurolidine and citrate (4%).
(Cyclo)-taurolidine has a broad antimicrobial activity (incl. MRSA and VRE)
against gram-positive and gram-negative bacteria and fungi.
Heparin = is an anticoagulant (blood thinner) that prevents the formation
of blood clots.
Alteplase = is a thrombolytic medication, used to treat acute ST elevation
myocardial infarction (a type of heart attacks), pulmonary embolism
associated with low blood pressure, acute ischemic stroke, and blocked
central venous access devices .

13. You have completed the module.
You can find more information regarding policy and
procedure on Connect under Guidance of Central
Venous Catheter as access for Haemodialysis.