This article is written by a Lecturer in Health Sciences. It focuses on the care and maintenance needed to keep such devices patent and functioning. It also describes some of the risks associated with such devices. Only adequately qualified persons should care for such devices.
In industrialized countries the use of central venous access devices is a common occurrence in hospitals, the home and retirement facilities. Many types of such devices are available. They are essentially used to give intra venous medications, obtain venous samples of blood and obtain measurements of central venous pressure. The main advantage of using these devices is that large volumes of fluids and medications can be administered quickly and safely both in the hospital and home settings.
Three of the most commonly used devices are the Porta cath, PIC catheter and the central venous catheter. Both the Porta cath and the PIC catheter have a single lumen only. The central venous catheter may have single or multiple lumen. The CVP catheter and the PIC catheters are usually inserted in the Juglar or Subclavian veins. Sometimes, the Femoral vein may be used.
Prior to insertion of one of these devices, informed, signed consent is routinely obtained from the patient. In some emergency situations this may be waived at the discretion of the treatment team. The purpose, the possible complications and potential benefits of these devices are explained to the patient. If the patient is a minor then the procedure is also explained to the parents. In elderly patients who cannot understand the procedure it is important to get the consent of the legal guardian or next of kin.
The thin end of the porta cath is inserted into the subclavian vein in aseptic conditions, usually in the operating theater. The dome is buried under the skin and is usually palpable just below the surface of the skin. At the point of insertion a scar may be visible. This type of catheter requires the least amount of maintenance because it is under the skin. All medications which are prescribed via this route can be given by cleaning the skin and injecting the medication into the dome, after palpating it. The injection site should be rotated so that skin healing takes place between injections.
It is routine to have an x-ray to insure that the catheter is in correct site.
Once the external wound has healed there is no routine maintenance.
Multi lumen catheters are commonly used in the hospital setting to give medications, obtain venous specimen of blood, measure central venous pressures and to obtain core temperature accurately. Central Venous catheters are inserted via the external jugular or subclavian veins. This procedure is usually done in the intensive care unit or the operating theater but can also be performed reasonably safely in the ward. A portable chest x-ray must be done to check placement prior to commencement of fluid and medication administration. The ports are color coded and each port has a different use.