November Update
Hi Everyone,
No live sessions planned this month as we did two the previous month. We have some exciting news to share, as we continue to grow we are looking to expand the work we do and the team running the Journal Club. Please check out the link below to apply
Whilst we are here, we thought it would be interesting to share a of a recent article along with a link for our community to explore:
Central venous catheters: Which, when and how
British Journal of Radiology, Volume 96, Issue 1151, 1 November 2023, 20220894,
Kehagias et Al
https://doi.org/10.1259/bjr.20220894
This paper provides an in-depth review of central venous catheters (CVCs), covering their types, usage, placement techniques, and associated complications. Central venous access, utilised for various treatments like chemotherapy, fluid therapy, and nutrition, is essential in modern healthcare, with millions of CVCs placed annually. CVCs are broadly categorised into non-tunneled and tunneled types, with further subdivisions for specialised uses.
Types of Catheters: Non-tunneled CVCs, including peripherally inserted central catheters (PICCs) and conventional CVCs, are typically for short-term use. Tunneled catheters, such as Hickman catheters and totally implanted ports, are for long-term use and preferred for discreet placement in patients needing ongoing access.
Selection Criteria: Device selection depends on vein accessibility, intended duration of use, and flow rate needs. Non-tunneled catheters are ideal for treatments up to three weeks, while tunneled devices or ports can last years. The implantation method, including whether ultrasound guidance is used, is critical for safe and efficient catheter placement.
Placement Techniques: The paper emphasises the importance of using ultrasound guidance for CVC placement due to its safety advantages. Preparation protocols, such as maintaining sterile technique and choosing the optimal patient position, reduce the risk of complications like infection and air embolism. Specific techniques for different catheter types are outlined, with PICCs and ports having unique insertion requirements.
Complications and Prevention: Complications, including pneumothorax, thrombosis, and infection, can arise during or after catheter placement. The paper provides recommendations on managing these risks, such as real-time ultrasound use, proper tip placement, and patient monitoring to detect complications early. In some cases, severe coagulopathies may be relative contraindications for CVC placement.
Conclusion: CVCs are a cornerstone of patient care in many treatments, with specific devices suited for diverse clinical needs. Proper technique, attention to detail, and adherence to protocols are critical for minimising complications and ensuring successful long-term outcomes in CVC use. The paper advocates for universal ultrasound guidance to maximize safety and recommends tailored approaches for each patient.
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