Installation Central Venous Catheters (CVC) is a procedure similar to infusion, but in a large vein. This procedure is carried out for long-term treatment that is risky when carried out through a regular infusion, one of which is is administration of chemotherapy drugs.
Installation of CVC is done by inserting a catheter into a large blood vessel, then directed to a central vein that carries blood to the heart. Installation of CVC is done in patients who are on long-term treatment, because the catheter can stay in the body for a long time.
When undergoing long-term treatment, nutritional intake and drugs cannot be given through an IV, because the infusion is only done for a few days and requires frequent needle changes. This can damage the blood vessels if it continues.
Based on the installation area and durability, CVC is divided into three types, namely:
- PICCline: mounted on the inner arm, and used for several weeks to several months.
- Tunneled CVC: chest mounted, for months to years of use.
- Subcutaneous port: permanently implanted in the chest, through a surgical procedure.
Indication Central Venous Catheters
Installation of CVC is carried out only under certain conditions, usually conditions that require repeated or long-term access to blood vessels, as well as conditions that pose a risk of injuring the blood vessels if only through regular infusions. Some examples of these conditions are:
- Blood sampling will be done many times.
- Administration of chemotherapy drugs.
- Dialysis or hemodialysis.
- Blood transfusion.
- Nutritional infusion.
- Administration of more than one type of drug at a time.
In addition, a CVC or central venous catheter is also placed when the doctor wants to check the pressure in the large blood vessels and as an entry point for a pacemaker. CVC is also often installed when someone is admitted to the ICU.
Installation Warning Central Venous Catheters
Patients with blood clotting disorders, for example due to a low number of platelets (platelet cells), need to be careful because CVC installation is at risk of causing bleeding. Installation of CVC in patients with sepsis can also exacerbate the infection experienced.
To be safe, discuss with the anesthesiologist the benefits and risks of CVC insertion before this procedure is performed.
Before Installation Central Venous Catheters
The doctor will do blood tests to make sure the patient does not have a blood clotting disorder. Then, the patient will be asked to fast 4-6 hours before CVC insertion.
Installation Procedure Central Venous Catheters
The doctor will clean and sterilize the area of skin where the catheter will be inserted, then inject a local anesthetic in the area.
After the anesthetic works, the catheter will be inserted into a large blood vessel with the help of ultrasound to prevent the catheter from slipping. Then the catheter will be attached to the skin by means of stitches or glued with special glue.
When the catheter has been installed, the area where the catheter is inserted will be cleaned again and covered with sterile gauze, while the outer end of the catheter will be connected to an infusion tube that is connected to the drug to be given. The outer end of the catheter can also be covered with sterile gauze when not in use.
Before the catheter is used, the doctor will perform an X-ray examination to make sure the catheter is in the right position. This is to prevent the drug from entering the wrong vein.
After Installation Central Venous Catheters
The following things need to be considered after undergoing CVC installation, especially if the CVC is still installed when the patient returns from the hospital:
- The area where the catheter was placed will be painful for 1-2 weeks, but this is normal.
- Always wash your hands before touching the outer end of the catheter, and always cover the area with a sterile bandage.
- Make sure the tip of the catheter is kept dry to prevent infection, and cover it with a waterproof material when bathing.
- Change the bandage once a week, and change it immediately when it gets wet or soiled. The nurse will teach you how to change the bandage properly.
- Rinse the connector daily to prevent blood clots, by injecting a blood-thinning medication, such as heparin.
- Set a reminder not to forget to change the bandage or change the catheter as the time approaches.
- Don't do sports that involve physical contact, such as soccer.
Installation Risks and Complications Central Venous Catheters
Although rare, CVC insertion can lead to a number of complications. Complications can occur due to errors during CVC insertion, or due to poor catheter care. Some of these complications are:
- Blockage at the tip of the catheter.
- The catheter slips out of position.
- Blood clotting.
- Bruising, bleeding, or infection in the area where the catheter was inserted.
- Heart rhythm disturbances, but only temporary.
- Accumulation of fluid in the chest cavity.