What are CVCs used for?

CVCs are used to administer medication or fluids that cannot be taken by mouth or, in the case of IV therapy, administer fluids or medications that would harm a smaller peripheral vein. CVCs are commonly used for:

Administration of long-term IV antibiotics or parenteral nutrition

Chemotherapy administration

IV therapy when peripheral intravenous access is impossible

Administration of medicines that cause phlebitis if given peripherally through a peripheral access device, e.g. amioderone, calcium chloride, potassium and dopamine.

What are the advantages of using CVCs?

Using a CVC has many advantages, as it can also allow for rapid administration of fluid (e.g. for a patient who is in shock). In addition, some CVCs have more than one channel (known as a lumen), which allows for different medications to be administered at the same time, without the medicines mixing together. Some medications (such as adrenaline, dopamine and amioderone) can only be administered centrally, as they cause vasoconstriction in veins.

CVCs generally have the following features:

Soft, hollow tubes that may be separated into two or three different channels (called lumens)

Screw-like adapters on the end of each lumen that allow caps, syringes and intravenous tubing to be connected to them

Hickman lines have plastic clamps on each lumen to close the catheter when it is not in use, or when disconnecting a cap, syringe or intravenous tubing.

CVCs are recommended for short-term use, due to the potential risk of infection (Loveday et al. 2014), and all devices should be removed as soon as they are no longer required.

CVCs can be inserted in the operating theatre, or at the bedside under sterile conditions (depending on the type of catheter used).

A tunnelled catheter is surgically inserted into a vein in the neck or chest and passed under the skin. One end of the catheter remains outside the skin. Medicines can be given through an opening at this end of the catheter. Passing the catheter under the skin helps keep it in place better, lets the patient move around more easily, and makes it less visible.

An alternative to this is an implanted port. An implanted port is similar to a tunnelled catheter, but the device is left entirely under the skin. It is normally placed below the clavicle into the right atrium of the heart, and is used for occasional or intermittent intravenous access. Medication is injected through the skin and into the catheter channel. An implanted port is less obvious than a tunnelled catheter, making it less visible and more acceptable to the patient.

How should healthcare professionals care for CVCs safely and effectively?

Following insertion, the catheter site needs to be regularly checked for signs of bleeding, redness, warmth or discharge. The signs of catheter-related problems and infection are similar for all types of CVCs.

Redness, tenderness, warmth or odour around the catheter site

Temperature of above 38° (or chills)

Swelling of the face, neck, chest or arm on the side where the catheter is inserted

Leakage of blood or fluid at the catheter site or the cap

Inability to flush the catheter, or resistance when flushing the catheter

Displacement (or lengthening) of the catheter.

Your local healthcare provider will have clinical guidelines for CVC care, and it is essential to familiarise yourself with them. These guidelines will vary, depending on where the CVC is being managed – in a hospital setting or in the patient’s home. Many patients at home will be taught to manage the care of their catheter themselves, with support from their local community nursing team.

Remember: you must always wash your hands with liquid soap and water, rinse them well and then dry them thoroughly. You must also wear personal protective equipment before and after touching the CVC (Loveday et al. 2014). To prevent infection, anything that touches the exit site or goes into the CVC must be sterile. An aseptic non-touch technique (ANTT) must be followed at all times when handling the CVC.

ANTT is a technique that was originally developed by Rowley (2001); it maintains asepsis and is non-touch in nature. ANTT is supported by evidence, highlights the key components involved in maintaining asepsis and aims to standardise practice.

The underlying principles of ANTT are:

Always wash hands effectively

Never contaminate key parts

Touch non-key parts with confidence

Take appropriate precautions against infection.

ANTT should be used for both central and peripheral line care, as Rowley (2001) argues that it can be counterproductive to promote two different techniques. The following guidelines are useful in preventing infection:

Only use sterile supplies – discard any products in opened or damaged packaging

Do not touch the end of the CVC when the cap has been removed

If the CVC has a clamp, keep it clamped when not in use

Apply strict ANTT principles as part of your CVC care

Always wear personal protective equipment – sterile gloves and an apron must be worn as a minimum requirement.

The CVC will normally be secured in place with a transparent dressing, unless it is an implanted port in which case a dressing will not be required. A transparent dressing is normally changed every 7 days (or more frequently if it becomes loose, damaged or soiled).

All dressing changes need to be undertaken using a strict aseptic technique to avoid the possibility of infection. Loveday et al. (2014) recommend daily cleansing with 2% chlorhexidine gluconate in 70% isopropyl alcohol in adult patients with a CVC, as a strategy to reduce infection. Iodine in alcohol can be used as an alternative for patients with sensitivity to chlorhexidine (Loveday et al. 2014).

What are the advantages and disadvantages of using PVADs?

Administration of IV therapy using a peripheral venous access device (PVAD) is simpler and cheaper and insertion is less traumatic for the patient, compared to inserting a CVC.