Lesson Summary

The placement of central lines has evolved over the years, with ultrasound being a primary tool to guide vessel access. The common techniques used are Seldinger or modified Seldinger for CVCs and PICs:

• A small needle is used to access the vessel, through which a guide wire is inserted.
• An introducer or catheter is then inserted into the vein through a small incision at the wire insertion site.
• The catheter and introducer are tapered to minimize trauma to the vein.

However, issues like phlebitis can still occur post-insertion due to reasons such as:

• Chemicals like chlorhexidine that irritate the vein if not allowed to dry completely.
• Poor insertion angle causing the catheter to rub against the vein wall.
• Inflammatory and clotting processes that may begin due to various factors.

Phlebitis, whether from mechanical or chemical causes, can be painful and even lead to thrombosis. The following are strategies for managing phlebitis:

• Heat, elevation, and anti-inflammatories may be used initially.
• If symptomatic, the line may need removal.

Thrombosis, specifically catheter-associated deep vein thrombosis (DVT), can occur around the catheter in the vein, potentially leading to obstruction of flow and symptoms like pain, edema, and redness in various parts of the body. Additional points to note regarding DVT include:

• Deep vein thrombosis is confirmed with ultrasound.
• Even if DVT is present if catheter is functioning and needed, it can be left and treated with anticoagulants

A lesser known problem caused by inflammation r/t CVCs is nerve injury.

• Inflammation to the cervical nerve from a line in the IJ could cause changes in the eye.
• Inflammation to nerves near subclavian placed lines could cause respiratory changes.
• In the arm signs of nerve injury includes "shooting pains" or paresthesia complaints.

Notify MD for suspected nerve injuries or paresthesia complaints.