WHAT ARE THE POTENTIAL COMPLICATIONS OF A CENTRAL LINE?

Like any medical procedure, the insertion of a Central Venous Catheter (CVC) can have potential complications.  Such complications are severely mitigated when an experienced and trained clinician uses best practices like the clinicians at Vascular Wellness.  While potential complications exist, there are tremendous benefits of a CVC such as the means to deliver medications, infusions, and fluid over a longer period of time especially those that can be more toxic or caustic or need higher flow rates.  In other words, these potential complications should not deter the usage of the Central Line as most medical treatments start with Vascular Access.

Complications can arise during and from the procedure (ie, the placement of CVC) and later while the CVC is in the patient even if not actively in use.  Some of the possible complications in no particular order include the following:

Central Line-Associated Bloodstream Infection (CLABSI)

Bacteria from the skin can access the body at the CVC line insertion site.  For example, the CVC insertion site should be monitored and scheduled sterile dressing changes and skin cleanings at the site should be considered.  A CVC placed in a fold such as in the elbow or groin area is more prone to bacteria and infections and thus, should be avoided which is why, for example, a poorly placed CVC in the groin to access the femoral vein can expose the patient to infection.

Collapsed Lung (Pneumothorax)

The needle in the CVC placed in the neck or chest can go through the vein or miss the vein and could pierce the lung, causing the lung to collapse.  If this happens, a small tube is used to re-inflate the lung.

Delayed Pneumothorax (after 24 hours) 

A patient who has symptoms of shortness of breath, cough, or chest pain after a vascular access procedure may be suffering from this complication.  If so, the patient should alert the nurse if still under care and treatment at a medical facility or go to the emergency room if outpatient.

Artery Puncture

This can happen when the needle punctures an artery instead of the vein during the insertion process.  The use of ultrasound reduces the risk as it helps guides the needle to the proper vein and distinguishes a vein from an artery.  A punctured artery can cause a Hematoma, which occurs when blood collects outside the artery.

Nerve or Vein injury

The can occur if the needle hits the nerve or vein during insertion.  Inflammation of the vein (Phlebitis) can also happen.  This risk is also reduced with a clinician who has mastery use of ultrasound guided technology.

Blood Clot (Thrombus)

The CVC can create a blood clot, causing the flow of blood to be blocked or impaired.  It generally needs immediate attention especially if the blood clot travels through the blood vessels and creates a blockage of blood flow to the heart, lungs (pulmonary embolism), brain or other organs.

Air Bubble in the Blood (Air Embolism)

During the CVC insertion, air may enter the vein.  An air embolism, like a blood clot, can travel through the blood vessels and block the flow of blood to the heart, lungs, brain, or other organs.  Immediate attention is generally required.

Irregular Heartbeat

This may happen during the line insertion near the heart and usually resolves after the line is in place.

While the CVC is inserted, it is important to be on the lookout for problems with the catheter. The catheter may become infected, blocked, or start coming out of the vein. If the catheter is red, tender or has swelling at the insertion site, it may be infected. If the catheter line is difficult to flush, it may be blocked.  Sometimes blood can flow back in to the CVC tubing and form clots or the line may kink.  If the catheter seems to be increasing in length outside the skin, it may be coming out of the vein.  To help mitigate risk of infection and some of these other issues, Central Line Care is extremely important.  See PICC Line and Midline Catheter Care | Vascular Wellness

Expertise using Ultra-Sound, experience with the touch and feel of threading the CVC, and constant practice and use of this skill set is essential.  The best Vascular Access Clinicians are those that specialize in this highly regarded and necessary practice area for medical treatment.