Central venous catheters (CVCs) are essential medical devices used for long-term access to the central vasculature, classified into different types based on their insertion method. Each type, including peripherally inserted central catheters (PICC), implantable ports, non-tunnelled, and tunnelled CVCs, has specific indications, durations, and potential complications, particularly relevant for patients with chronic kidney disease. Proper technique and monitoring are crucial to minimize complications and ensure effective treatment.

1. CENTRAL VENOUS CATHETERS (LINES)
Dr. Ahmed Mostafa Khalaf ,MD
Lecturer of Diagnostic and Interventional Radiology
Faculty of Medicine, South Valley University

2. INTRODUCTION

3. Background
Central Venous Catheters (CVC) also known as a central line or a Central Venous
Access Device (CVAD) are indwelling devices inserted into a vein of the central
vasculature.
They can be classified as Non-Tunelled, Tunelled, Peripherally inserted and Totally
implantable, depending on how the catheter is inserted.

7. CLASSIFICATION

8. CENTRAL VENOUS CATHETERS (LINES)
Peripherally
inserted central
catheters (PICC)
Implantable
ports
(portacath)
Non-
Tunnelled
CVCs
(Vascath)
Tunnelled CVCs
(permacath,
Hickmann)

9.  A PICC line is a long, thin tube that goes into your
body through a vein in your upper arm. The end of
this catheter goes into a large vein near your heart.
 Duration: Medium term (weeks to months, up to 1 year)
 Indications: Difficult intravenous access; blood sampling;
medium term drug administration (e.g.
antibiotics); administration of irritant drugs (such as
chemotherapy); total parenteral nutrition
 A PICC is never used for dialysis.
Peripherally inserted central catheters (PICC)

10.  The PICC line use is associated with many complications such as
phlebitis/thrombophlebitis, venous thrombosis, catheter-related
infection, wound infection, and central vein stenosis
 These complications are far more deleterious for patients with chronic kidney
disease (CKD) whose lives depend on a functioning hemodialysis access once they
reach end stage kidney disease (ESKD)
 PICC lines should be avoided in CKD stage III-V. If a central line is needed, then a
tunneled small-bore CVC is preferred

11.  Line that is surgically placed into a vessel,
body cavity, or organ and is attached to a
reservoir or “port” located under the skin
 Indications:
 Patients with regular hospital admissions with
poor intravenous access
 administration of irritant drugs (such as
chemotherapy
 Duration: long term (months to years, for
intermittent or continuous access)
Implantable ports (portacath)

12.  The catheter tip is placed at the junction of the superior vena cava and
the right atrium
 Non-coring needle (Huber needle) is needed to access the device

13.  Also called Percutaneous and Non-Cuffed CVC
 Temporary venous access and in emergency situations
 The catheter is inserted by puncturing directly into
the skin and vein without tunneling the
subcutaneous tissue
 Duration: short term (days to 3 weeks)
Non-Tunnelled CVCs (Vascath)

14.  Indications: Difficult intravenous access; infusion of irritant
drugs, vasopressors and inotropes; short term total
parenteral nutrition
 Catheter Tip is positioned within :
 the right atrium (if soft silicone catheter)
 at the junction of the superior vena cava with the right atrium
(if polyurethane catheter, to avoid right atrium wall damage)

15. Tunneled Non Tunneled
Needs a tract under the skin No
Cuffs No
Longer tract or tube Short
Long-term access Short-term access

16.  Line in which the proximal end of the catheter is
tunneled subcutaneously from the insertion site
and brought out through the skin at an exit sit
 The catheter has a cuff that acts as a barrier to
infection; allows tissue to grow around the catheter
thereby providing stability to the catheter and
preventing catheter movement
 The catheter tip is placed at the junction of the
superior vena cava and the right atrium
Tunnelled CVCs (permacath)

17.  Duration: long term (months to years, for intermittent or continuous access)
 Indications :Haemodialysis, medications, nutrition, and fluids
 Site :IJV (RT….LT), SCV (RT….LT), Femoral vein (LT…RT), EJV,
translumbar or transhepatic, peritoneal dialysis.

18.  Technique
 Informed consent.
 Vascular access history.
 Clinical examination.
 Vascular access life plan.
 Pre-procedure lab work-up:
- Coagulation profile.
- Septic screen.

19.  Good local anesthesia.
 Test and prim the catheter.
 Use of ultrasound to guide insertion.
 Use of Fluoroscope to guide the
position of catheter tip.
 Optimize length of catheter

21.  Early Complications
 Hematoma formation
 Haemothorax
 pneumothorax
 Late Complications
 Infection
 Venous thrombosis
 Catheter thrombosis
Complications

22.  Radiological placement is more reliable than surgical
placement; there are fewer placement complications and
fewer catheter infections overall
 It is convenient for patients, quick, time saving and cost
effective.
Take home message