Central Line Insertion- Indications, Contraindications, and Complications

Introduction

A central line comes in extremely handy for the patient and makes the healthcare provider’s task much more manageable. A central line is a wide-holed catheter that is inserted in the veins. This insertion is typically done with the help of a sterile technique. In case the patient is extremely unstable, sterility becomes a secondary issue of concern. A few forewarnings for central venous line placement comprise fluid resuscitation, drug infusion, blood transfusion, central venous pressure monitoring, emergency venous access, pulmonary artery catheterization, emergency venous access, and transvenous pacing wire placement.

A central line is mandatory when an individual needs to receive drugs via the veins over a long period of time. It is also necessary for the state of kidney dialysis. The reason is, that in these conditions a central line is much easier and way less painful than continuous needle insertion. Central line insertion is also helpful for measuring the fluid volume status in an individual in order to help examine the patient for dehydration. Central line placement is brought about in an X-ray room by a group of professionals, mainly a radiologist and a team of specially trained nurses. The radiologist places a tiny tube in the vein under the shoulder bone and anchors it by forming a thin tunnel beneath the skin. The tube stays in the same position as long as needed.

When Is Central Line Insertion Indicated?

There are several reasons and indications for making a decision to go along with central line insertion. Mentioned below are a few of the most common manifestations of central line insertion.

• Fluid resuscitation.

• Resuscitation of blood products.

• Emergency medicine.

• Drug infusions in order to ward off the development of phlebitis or sclerosis.

• Long-term antibiotic therapy.

• Hyperosmolar solutions.

• Vasopressors.

• Central venous pressure monitoring.

• Chemotherapy.

• Pulmonary artery catheter introduction.

• Multiple blood tests in a short period of time.

• Emergency venous access.

• Difficult peripheral intravenous access.

• Kidney dialysis.

• Measurement of bodily fluids.

• Long-term treatment.

• Transvenous pacing wire placement.

• Self-treatment at home.

When Is Central Line Insertion Contraindicated?

Central line insertion or central line catheters are contraindicated in certain conditions if there are high chances of complications and risks to the patient.

Mentioned below are a few of the contraindications of central line insertion.

• Coagulopathy.

• Local infection.

• Raised intracranial pressure.

• Absence of femoral approach.

• Non-compliance of patients.

What Are the Complications of Central Line Insertion?

Complications and risks are a part of any procedure in medical science. This is why a consent form should be taken from the patients after explaining the possibilities of potential complications.

Mentioned below are some of the complications of central line insertion.

• Pain at cannulation site.

• Local hematoma.

• Infection.

• Bacteremia.

• Misplacement into another vessel.

• Arterial puncture.

• Cannulation.

• Vessel laceration.

• Vessel dissection.

• Air embolism.

• Thrombosis.

• Pneumothorax.

• Requiring a possible chest tube.

What Are The Equipment Used for Central Line Insertion?

The neck, collar bone, and groin are the usual sites for central line insertion. The reason is that they have large palpable veins. There are different types of central line insertion- triple-lumen, dual-lumen, and large bore single-lumen. The majority of the central line insertion kits include the following apparatus.

• Syringe.

• Needle for local anesthetic.

• A small vial of 1% lidocaine.

• Syringe and introducer needle.

• Scalpel.

• Guidewire.

• Tissue dilator.

• Sterile dressing.

• Sterile gauze.

• Suture and needle.

• Central line catheter.

• Sterile saline.

• Chlorhexidine.

• Ultrasound.

• Sterile ultrasound gel.

• Sterile ultrasound probe

How Is Central Line Insertion Done?

Mentioned below are the steps on central line insertion.

• The skin around the place of insertion and neighboring tissues will be anesthetized with 1% lidocaine.

• An ultrasound is used in order to find the target vein of insertion.

• The needle is inserted, and the nearby artery is simultaneously pulsated.

• The introducer needle is then slowly advanced under constant ultrasound guidance to make sure the tip does not get lodged in an incorrect vessel.

• Ultrasound is done parallelly to avoid the vein’s puncture through the distal edge.

• The guidewire is carefully threaded into the introducer needle hub.

• While still holding in place the guidewire, the introducer needle hub is removed.

• Ultrasound in two different views confirms the correct placement of the guidewire in the target vein.

• A scalpel tip is used to make a little stab on the skin against the wire large enough to place the dilator.

• This place will eventually hold the central venous catheter.

• The dilator is inserted in a smooth twisting motion.

• The central line insertion is then advanced over the guidewire.

• The distal end of the central line is uncapped.

• Uncapping the distal lumen facilitates easy passage of the guidewire.

• Once the central line insertion is in place, the guidewire is removed.

• Every port of the sterile saline is flushed.

• A suture is placed to secure the central line insertion.

• Lastly, a sterile dressing is made on the site of insertion.

Conclusion

A central line insertion is an aid to several treatment modalities. It is a type of catheter inserted into a large vein of the body, such as those present in the collar bone, neck, or groin. It makes drawing blood from patients uncomplicated and permits the transfer of vast quantities of fluid necessary for medication and hydration. The central line insertion can easily remain put for weeks to months. Central lines are strictly inserted under sterile conditions in case the patient is not in a state of emergency. At the same time, final placement is always confirmed through ultrasound and an X-ray. There are many uses of central line insertion, such as delivering medications, allowing for dialysis to be performed, making blood draws easier, measuring fluids, and many more. They have some benefits that standard intravenous methods do not. One of them is that they can be left in for months rather than a couple of days.