Central Line Insertion and Associated Challenges

Central line insertion can be a complicated process that requires proper training to minimize procedural risks. One of its most important aspects is the proper positioning of the patient during the procedure to ensure safety and success. Patients may also have anatomical variations or previous surgeries that may make it difficult to locate the vein or insert the catheter. 

Air embolism can occur if the catheter is not inserted or positioned correctly. Central line insertion increases the risk of infection, particularly at the insertion site. Blood clots (thrombosis) can form around the catheter, leading to serious complications such as pulmonary embolism or stroke. The catheter can be dislodged from its original position, leading to bleeding and other complications. 

It is important that healthcare professionals be aware of these potential challenges so they can take the necessary precautions to minimize these risks during central line insertion procedures.

Risk of Infections Based on Site Selection

central line insertion

Numerous studies have been conducted to study the comparative risks based on site selection for central line insertion. According to findings, central line insertions in the subclavian and interval vein have lower chances of infection compared to those in femoral locations. 

The subclavian and internal jugular veins are considered less prone to infection and thrombosis compared to the femoral site because they are located in a more central area of the body and closer to the heart. This means that blood flow in these areas is generally higher and more consistent which can help reduce the risk of blood clots. 

Additionally, these locations are less likely to be exposed to external contaminants such as bacteria which can help reduce the risk of infection.

In comparison, the femoral location is more likely to be infected because of its proximity to the skin and the external environment. It is also more likely to be thrombotic because the blood flow in the femoral vessels is slower than in the subclavian and internal jugular.

Bleeding Risk Categorization

The 2019 Society of Interventional Radiology (SIR) for Periprocedural Management of Image-guided Procedures conducted a study on the risk of bleeding in procedures involving central line insertion. 

The study was conducted over a period of two years and included patients who underwent interventional procedures in four different centers. The findings were used to establish guidelines and risk categories for medical practitioners.

This clinically relevant bleeding risk categorization system for interventional procedures in vascular and interventional radiology divides bleeding risks into three categories: low, intermediate, and high.

The system is based on a combination of patient-related and procedure-related factors. 

Procedure Related Factors

The study found that procedure-specific bleeding risks can be accurately predicted by this categorization system.

Findings suggested that the majority of procedures (83%) were classified as low risk with the remaining 17% being classified as intermediate or high risk.

The study also found that procedure-related factors that were associated with a higher risk of bleeding included the use of a guide wire, the use of a large-bore catheter, and the use of multiple catheters. 

Patient-related Factors

Patient-related factors that were associated with a higher risk of bleeding included older age, a history of bleeding disorders, and the use of anticoagulant therapy. 

The risk of bleeding due to old age was potentially linked to an increased likelihood of comorbidities and changes in the blood vessels that occur with aging.

A history of bleeding disorders was also found to be a major factor that is associated with a higher risk of bleeding and must thus be properly assessed before the procedure. Patients with histories of bleeding disorders have a tendency to not form clots as efficiently which can increase the risk of bleeding during and after the procedure.

Patients using anticoagulant medication for certain conditions were also observed to display a higher risk of bleeding and its stoppage.

The categories developed by SIR can be used to aid decision-making in interventional procedures and for informing patients about the potential risks associated with it.

It is extremely important that healthcare providers have a thorough knowledge of such medical findings so that they can take the necessary precautions at every step while being aware of the patient’s medical history and how it might impact central line insertion.

Conclusion

Central line insertion can be a fairly safe medical procedure with expert technicians and medical practitioners who are certified to administer it. 

After the procedure, the insertion site is typically covered with a bandage and kept dry for 24 to 48 hours. The patient may experience some soreness or discomfort at the insertion site but this usually subsides in a few days.

If you would like to learn more about central line insertion, Hospital Procedures Consultants (HPC) offers a course on the subject that features hands-on training, simulators, and safety training for troubleshooting rare scenarios. 

Who Is HPC’s Central Line Insertion Training For?

A deeper understanding of central line insertion is included in HPC’s live Hospitalist and Emergency Procedures course. It is taught along with 20 of the most essential procedures that are commonly used in hospital wards, emergency rooms, and intensive care units.

HPC’s central line insertion training is intended for nurses, physicians, physician assistants, and other healthcare professionals who are involved in the care of patients with central lines. It is designed to provide them with the necessary knowledge and skills so they can improve the safety of central line insertions while reducing the risk of complications.

The course covers topics like indications for central line insertion, the risks and benefits associated with the procedure, the different types of central lines, and the anatomy and physiology of the central venous system among others.

Visit the HPC website for additional information.

 

References

Parienti JJ et al.  Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial.  JAMA. 2008 May 28;299(20):2413-22

Timsit JF et al. Jugular versus femoral short-term catheterization and risk of infection in intensive care unit patients. Causal analysis of two randomized trials.  Am J Respir Crit Care Med. 2013 Nov 15;188(10):1232-9.

Parienti JJ et al.  Intravascular Complications of Central Venous Catheterization by Insertion Site.  N Engl J Med. 2015 Sep 24;373(13):1220-9.

Lorente L et al.  Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Crit Care. 2005;9(6):R631-5.

Practice Guidelines for Central Venous Access 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2020; 132 (1): 8-43

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