Central venous access is a commonly performed procedure where a catheter is placed into a large vein in the body to administer medication, monitor venous pressure, and introduce fluids during certain tests.
More than five million central venous catheters are inserted into hospitalized patients in the United States each year. Placement of the catheter can vary depending on patient related factors and can be temporary or permanent.
Catheter Locations and Uses
Jugular (neck): The jugular veins are used for temporary and permanent catheters or ports to monitor a patient’s vital signs such as an ECG, heart rate, blood pressure, central venous pressure, temperature, peripheral venous oxygen saturation, and blood gas analysis.
Subclavian (chest): The subclavian veins are a common site for temporary and permanent central venous access for treatments such as chemotherapy, prolonged antibiotic therapy, and parenteral nutrition.
Femoral (groin): A femoral catheter may be necessary when access to the circulatory system is compromised and no other site for placement is available to administer large fluid volumes or potentially irritating medicines. It also provides temporary access for emergency situations and is the preferred catheter location for critically ill children.
Types of Central Venous Catheters
Tunneled Catheter: A tunneled catheter is passed through a vein under the skin from an insertion site to a separate exit site, where the catheter and its attachments emerge from underneath the skin. The entrance site is most commonly placed in the neck (jugular) but may also be placed in the groin (femoral), or chest (subclavian).The exit site is typically located in the chest, making the access ports less visible than if they were to directly protrude from the neck. Passing the catheter under the skin helps to prevent infection and provides stability for long-term use. Tunneled catheters are considered “permanent” because they can remain in place from seven days to twelve months.
Non-Tunneled Catheter: A non-tunneled catheter is considered “temporary” and does not pass through a vein to a separate exit location. Like the tunneled catheter, the entrance site can be in the neck (jugular), groin (femoral), or chest (subclavian). Patients that require non-tunneled catheters are at risk of injection at the entrance site so care must be taken to keep the area clean. Non-tunneled catheters are considered “temporary” because they only remain in place for a few hours or days.