![]() ![]() Tunnelled CVCs are often referred to as Hickman lines, although Hickman is a trade name. They may have single or multiple lumens and each lumen is fitted with a clamp. These lines are usually inserted via the subclavian, jugular or femoral veins (Todd, 1998) and secured to the patient’s skin using non-dissoluble sutures. Insertion may be in response to an emergency or a planned event. Department of Health guidelines (2001) suggest the use of antimicrobial-impregnated catheters, but only in the short term for patients at high risk of infection.Ĭentrally inserted non-tunnelled CVCs are most commonly used for patients in acute settings where the catheter will be needed only for a few days or weeks. Research suggests a possible advantage in using catheters impregnated with an antiseptic or antimicrobial coating (Pearson and Abrutyn, 1997), although this is controversial. However, in high-dependency settings, large bore lines and multiple lumens tend to be used because they are essential for the management of acutely ill patients.Īnother issue facing those who purchase and select CVCs is the material they are made of. As a general principle the lumen diameter and number of lumens should be kept to a minimum as larger bore catheters and multiple lumens are associated with higher risks of infection and thrombosis (Jones, 1998). This allows two incompatible drugs or fluids to be infused simultaneously. With multiple lumen lines, each lumen provides independent access to the venous circulation. ![]() Most CVCs come in different sizes with single or multiple lumens. ![]() The choice of device depends on the purpose for which it is intended, although patient preference may be a key factor with long-term catheters. This series discusses four types of CVC: centrally inserted CVCs, tunnelled CVCs, peripherally inserted central catheters (PICCs) and implantable ports. This means that irritant drugs or fluids can be easily infused without damaging the vein wall. The tip of the catheter should be placed in the superior vena cava, just above the right atrium (Todd, 1998), where the blood flow around the catheter is far greater than in a peripheral vein. The term CVC refers to any intravenous catheter whose tip lies in a large central vein, giving what is termed ‘central access’. In other areas, such as cancer care, they may be used for patients undergoing long-term, continuous or repeated intravenous treatments, such as chemotherapy, and for blood sampling. In acute care, they enable rapid and reliable intravenous administration of drugs and fluids and are used to monitor central venous pressure. Liz Simcock, BA, RGN, is clinical nurse specialist for central venous access, Meyerstein Institute of Oncology, Middlesex Hospital, LondonĬentral venous catheters (CVCs) are used in a wide variety of settings. ![]()
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