Central Line Catheters and Associated Complications: A Review

Abstract

The use of a central line or central venous catheterization was brought to attention in 1929 when Dr. Werner Forssmann self-inserted a ureteric catheter through his cubital vein and into the right side of his heart. Since that time the central line technique has developed further and has become essential for the treatment of decompensating patients. Central lines are widely used for anything from rapid fluid resuscitation, to drug administration, to parenteral nutrition, and even for administering hemodialysis. Central lines come in different sizes, types, and sites of administration. Sometimes their use can be associated with complications as well. The following review article addresses these parameters of central lines and goes into detail regarding their complications.

Keywords: bleeding; catheter knot; central venous catheterization; complication; complications; infection; pneumothorax; subclavian vein cannula insertion.

Figure 1. Chest radiograph showing a central line

This is a right-sided central line in internal jugular vein (the tip is pointed out by the orange arrow). The central line is positioned near the right tracheobronchial angle (pointed out by the yellow arrow) [3].

Figure 2. A peripherally inserted central catheter

The above figure is a photograph of a patient's cubital fossa showing the insertion site of a peripherally inserted central catheter (PICC) [6].

Figure 3. The site of a central line insertion into the subclavian vein

The needle for the venous catheter must pass immediately beneath the junction of the medial one-third and lateral two-thirds of the clavicle (pointed out by the black arrow). The puncture must occur at a point 1-2 cm inferior and lateral to the junction (as marked by the black star) [3].

Figure 4. The site of a central line insertion into the internal jugular vein

For the site of a central line insertion, the essential surface anatomy comprises the borders of Sedillot’s triangle. Sedillot's triangle comprises the sternal head of the sternocleidomastoid muscle medially (pointed out by the yellow arrow), the clavicular head of the sternocleidomastoid laterally (pointed out by the orange arrow), and the superior border of the medial third of the clavicle inferiorly (pointed out by the red arrow) [3]. The position of the appropriate cutaneous puncture is at the apex of the triangle (as marked by the black star).